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OX TUE DISEASE CALLED 



YELLOW FEVER; 

Wm OBSERVATIONS CONCERN!' 

FEBRILE CONTAGION, TYPHUS FEVER, 
DYSENTERY, AND THE PLAGUE, 

IaIIIIV DELIVERED AS THE 

<£ulstontan UrrtuirG, 

DEI Tin: 
IN 1 111. | | LBfl 1-SOf) AND 1807. 

BT Einr.iiii) .v.irn.i.viKL n.i.vritotr, M i>. 

>>S rursn | LATE 

PUIHIUA3 TU b I liOMMTAL 

\N!> KKIM BUSHED, \\ III! NOTES, 

BY JOILY B. TMVIDGE, ./. .)/. JK D. 

AN1> PROFESSOR Oi IV Of THE UNIVERSITY OF MARYLAND. 



" I - jn Mt inKis cacher la cause d'un ph< MM 

1 ..lis I'eireur Public *n Ben dc ■ \<nu- in < fta let progres de la MWM 

bubsutue del sot. iniui 1 1 •<> :iu- la nature. — II est des erreunj t : 

•|iii touclienl lis. Iiomrncs dt-s plus B ml sRlllj 

luteal I* ions. : 1 .11 ukUvmIu. — Fontunu rur let Pc 

Wm/| tome i. pi 



kJalttmorr: 
PUBLISHED BY GUSHING AND JEWETT. 

J. Kobinson, priutcr. 

1821. 




^ » v.\ * • *■•• * * * * 



\ 



District of Maryland, Set. 

BE IT REMEMBERED, That on the tenth day of February, in the Forty- 
fifth year of the Independence of the United States of America, Joseph 
*k******M« CtrsHiKGand Joseph J*ewett, of the said District, have deposited in this 
$SEAL.* Office the title of a Book, the right whereof they claim as proprietors, in 
*********** the words following, to wit : 

"An Essay on the disease called Yellow Fever; with observations concerning 
" Febrile Contagion, Typhus Fever, Dysentery, and the Plague, partly delivered 
"as the Gulstonian Lectures, before the College of Physicians, in the years 1806 
"and 1807. By Edward Nathaniel Bancroft, M. D. Fellow of the Royal College 
" of Physicians, Physician to the Army, and late Physician to St. George's Hospital ; 
"and republished, with Notes, by John B. Davklge, A. M. M. D. and Professor 
"of Anatomy in the University of Maryland. 

"L'ignorance d'une verite en Physique peut nous cacher la cause d'une pheno- 
"mene naturel ; mais I'erreur etablie au lieu de la verite arrete les progres de la 
" science, et substitue des songes et des chimeres aux faits, et a la nature. — II est des 
« erreurs et des verites qui touchent les hommes des plus presque les autres, et ce 
" sont surtout celles qui regardent la conservation de son individu. Fontana sur les 
"poisons et sur les Corps Animal, tome i, page 97, 4to. 

In conformity to an act of the Congress of the United States, entitled, "An 
act for the encouragement of learning, by securing the copies of maps, charts, 
and books, to the authors and proprietors of such copies during the times therein 
mentioned." And also to the act, entitled, " An act supplementary to and to amend 
the act entitled, " An act for the encouragement of learning, by securing the copies 
of maps, charts, and books, to the authors and proprietors of such copies during 
the times therein mentioned, and extending the benefits thereof to the arts of 
designing, engraving, and etching historical and other prints." 

PHn^P MOORE, 
Clerk of the District of Maryland. 



u& 



INTRODUCTION. 



Whatever obstructs the progress of science, or 
throws a shade over the research of philosophy, is a 
subject of fair and legitimate criticism. Truth, phy- 
sical, moral, or political, is the common property of so- 
ciety ; and every member of the literary whole, may, ac- 
cording to taste and ability, enlarge its bounds, or pro- 
mote its interests. Where motive is ingenuous, it is 
commendable; and manner, though awkward, may be 
pardonable. But before we write, we should think; 
and before we publish, we should at least understand 
the nature, if not the extent of the subject, on which 
we are about to admonish the world. The publick, 
however ready to learn, is impatient of unprofitable in- 
trusion. Vanity may invite derision, but knowledge 
alone communicates information. 

The man who conceives that the use of writing con- 
sists in the multiplication of books, mistakes the adula- 
tion of private vanity for the approval of publick senti- 
ment. It is the pleasure or the caprice of the many to 
write, the good fortune of the few to convey knowledge. 



IV INTRODUCTION. 

In the reiteration of what has been said, is not always to 
be found the illustration of what is valuable. 

The promotion of science, the encouragement of arts, 
the amusement of the curious, or the polish of the social, 
appears to be the chief, if not only object for which the 
pen is properly used. And every writer who undertakes 
to maintain, with success and understanding, a discus- 
sion, or to arrive at any satisfactory conclusion, through 
a process of reasoning, must in the first place settle his 
principle and define his object. 

Dr. Hosack, by undertaking to write a nosology, prac- 
tical he terms it, necessarily pledges himself to throw 
additional light on what is already befoi e the profession, 
or to give something new. Merely to repeat what has 
been uttered, were to fatigue himself, and disappoint 
his reader. 

The learned author, in his preface, offers the most 
ample opportunity for us to believe that nosology, the 
science of disease, is not a branch of natural history; 
that it is a thing indeterminate in form, and mutable in 
principle. * or he says, that " in the details, 4iowout, 
of the synopsis now to be submitted, it will be readily- 
perceived, that I have been more solicitous to convey | 
distinct enumeration of the ckaracteristick or patlio°iw- 
monick symptoms of diseases, and to form those associa- 
tions which are connected with their cure, than to ob- 
serve the rigid rules exacted by the the naturalist in the 
formation of the genera and species." 

* See Pref. p. viii* 



INTRODUCTION. 

The rigid rules exacted by the naturalist, in the forma- 
tion of genera and species, can only be such as an 
honest and faithful history of the distinctive characters 
may suggest, by which animals, vegetables, and mine- 
rals, can be formed into genera and species. Any other 
rules would be absurd and beside the subject. And 
these rules can be derived from no other source than 
nature herself, in her varied forms. 

The formation of genera and species, pre-supposes 
distinctive characters ; and to be distinctive, the charac- 
ters must be regular, otherwise they could not consti- 
tute rules to the naturalist, nor would the naturalist be 
intelligible to his reader, when he might speak on his 
genera and species. 

The writer says, u that I have been more solicitous 
to convey a distinct enumeration of the character istiek 
or pathognomonic!; symptoms of diseases" &c. 

The writer's object clearly appears to be a distinct 
cmunwation of those symptoms which are character- 
istick of diseases, and such as will enable him to " form 
those associations" which are connected with their 
cure ; and no doubt to be intelligible to his readers, was 
a part of his purpose. And yet he tells us, that he is 
not to be expected to observe the rigid rules exacted by 
the naturalist. 

To the naturalist there is no other rule than that 
which is derived from characteristick or distinctive phe- 
nomena, nor indeed can there be. The ingenious no- 
sologist assures us, that his object is to convey a distinct 



VI INTRODUCTION. 

enumeration of the characterietick or pathognomonick 
symptoms of diseases, «Src. Then by what rale does the 
author attempt to convey a distinct enumeration of pa- 
thognomonick symptoms? If not by the rigid rule ex- 
acted by the naturalist, by what other rule does he at- 
tempt to form a distinct enumeration or association of 
symptoms? 

As the author admits that diseases have their distinc- 
tive or pathognomonick signs, and indeed such a conces- 
sion is implied in the very attempt distinctly to enume- 
rate the symptoms, in what does the nosologist differ 
from the naturalist? Each is bound, by the ordinal? rules 
of history and narrative, to give an ingenuous statenx nt 
of those characters that are indicative of the genera and 
species, or, in other words, proper to their subje- 

If a distinct enumeration (what is not essentially regu- 
lar, cannot be distinctly enumerated,) can be given of 
pathognomonic!; symptoms of diseases, in the very ad- 
mission itself, disease is allowed to be fixed and deter- 
minate in its nature; and of nece*>itv. disease is a part 
of natural history. It is not presumed that disease is the 
production and intention of art, although it may be, at 
times, the result of casualty. 

By what the writer admits, it is conceded, that no- 
sology is a science; and that there are other sciei 
denominated natural sciences, or branches of natural 
history. It is also suggested by the necessan import of 
the assumption, that the sciences of nature, in object 



INTRODUCTION. Vll 

and principle, are fixed; but that the science of nosology 
or disease, is variable and indeterminate. 

The end of the following pages is to show that no- 
sology is a science; that it is, radically and fundamen- 
tally, fixed and immutable in its nature and character; 
and that it is a physical or natural science, attended by 
as few marked or sensible variations as any other branch 
of natural history equally extensive. 

Were disease mutable in its fundamental laws, it 
could exhibit no general or uniform phenomena. The 
doctrine of disease would become a mere object of 
speculation. In it there would be nothing regular or 
formal on which the understanding could exercise its 
powers, much less could any gentleman, possessed of in- 
tellectual sanity, undertake to give to the world a distinct 
enumeration of those signs which should be pathogno- 
monic^ and by which future generations are to distin- 
guish one kind of disease from another. 

•• It is not, indeed, to be contended.** says Mr. Good, 
t; that the distinctive signs of diseases are as constant and 
determinate as many of the distinctive signs that occur in 
zoology and botany; and so complicated is the animal 
machinery, so perpetually alterable and altered by cli- 
mate, idiosyncrasies, and the many accidental circum- 
stances by which life is diversified, that the general rule 
must admit of a variety of exceptions, and is here, per- 
haps, rather than any where else, established by such 
exceptions. M 

Dr. Ho9ack's pref. p. viii. 



VIII INTRODUCTION. 

With the opinion, certainly not argument, of this clas- 
sical writer before his eye, the author of the nosology 
undertakes to convey a distinct enumeration of the cha- 
racteristick or pathognomonick symptoms of diseases; 
constant or determinate signs. 

If the signs be not constant or determinate, will ii 
nuity itself explain now a distinct enumeration of symp- 
toms characteristick and pathognomonick of diseases 
can be given ? 

To say that signs are not determinate, and yet are 
characteristick of diseases, b to lay tin- rational mind 
under a serious contribution, and awaken sentiments of 
compassion. 

"That the distinctive signs of diseases are not as con- 
stant as the distinctive signs that occur in zool< gj 
botany; and so complicated is the animal machinei \ 
perpetually alterable and altered |j habit, climate. 
&c." is one of those bold and gratuitous assertions which 
forces us to appeal to the observations and records of 
naturalists, in regard to auimal life. Alterations in ani- 
mal life, to be entitled to consideration, must mean/urn/**- 
?ncntal and radical If animal machinery be fundamen- 
tally alterable and altered, what preserves the races of 
animals distinct? How is it ;hat the horse has not de- 
generated into the monkey, and man into the ass? 

Upon what principle will learned gentlen lain 

how the signs in zoology are constant and distiiu 
and yet the animal machinery so alterable and >o altered 
as to call for exceptions to general rule* 



INTRODUCTION. IX 

Either the animal machinery is not alterable or al- 
tered, radically, or the signs of the animal economy 
cannot be distinctive. What is not constant, is not 
distinctive. And what is altered, is not constant. Does 
animal machinery refer to the human animal only? Is 
the brute an animal? Or does zoology treat of ani- 
mals? And if the reference, by the learned writer, be 
to man only, is the human more alterable than the brute 
animal? Or either, than vegetables? 

It is below the dignity of science, aud insulting to the 
human understanding, to bring such follies before the 
publick eye. Mr Good may be very classical, in the 
opinion of the gentlemen of New -York, but certainly, 
he is neither very intelligible, nor philosophical. 

"It is true,*' says Dr. Young, " that ue must not ex- 
pect the same rigid accuracy in medicine, that ma\ be 
obtained in some of the departments of natural his- 
tory, since, in fact, many of the distinctions which are 
required in a nosological method, are rather established 
for the sake of practical convenient < ," &c. &.c. 

Nothing can be more unintelligible aud inexcusable, 
than this confusion of nosology and general medicine. 
The subject before the reader, and that to which his 
attention is called by Dr. Hosack, is the science of no- 
sology — the science of disease. The science of medi- 
cine involves more extensive considerations. 

Nosology is a discourse on disease, as it is cognizable 
by its diagnosticks or more characteristick signs. In 
other words, it is the science of pathognomonicks. 
This appears to be the acceptation and import of the 

2 



X INTRODUCTION. 

term, by all medical philosophers, from the earliest 
periods in which the science has been cultivated. 

Human nosology, then, is that discourse which treats 
of the diseases, in their sensible characters, to which 
the human body is liable. 

Disease is, essentially, in nature, in laws and phe- 
nomena, the same, whether art interfere or not. The 
intention of art is not to produce, but remove di^< 
Hence it follows, that the science of DftMl be 

viewed apart from that art which human ingenuity and 
skill employ for the removal of disease. No two things 
can be more distinct. The small-pox occurring in the 
savage, at the dmmI remote distance from professional 
aid, is the same in signs and nature, as that which I 
place in civilized life. In the eye of - 
ease, and the art resorted to for the removal of the 
ease, are mutually opposed in fact and nature, how 
intimately, in the views and practice of the profession, 
they may be associated. 

The science of niedieine i< geuefffdj that of nosology 
particular. Nosology refers to nature, ineumben <: 
disordered in her functions; art to human skill, ad- 
dressing itself as well as it may to the removal of dis- 
ease and restoration of health. 

Art, in its address to the removal of disease, mar 
vary; and vary it will, according to experience, t 
ucation, to intellectual ability. Different intell 
viewing the same phenomena, will make different de- 
ductions, as those intellects may be vigorous or feeble ; 
educated or ignorant - y liberal or prejudiced. But to 



INTRODUCTION. XJ 

detain the reader longer in pointing out the incongruity 
and absurdity of extending our views to general prac- 
tical medicine, in a discourse professedly on nosology, 
were to offend his good sense. What the writer can 
mean by a practical nosology, I must leave to his own 
interpretation. 

That nosology furnishes the signs from which the 
rules of practice are deduced is true, for it furnishes 
the only means by which the professional man can form 
any idea whatever of the particular condition of the 
body against which art directs its force. But yet it 
constitutes no part of the therapeutriek scheme, and 
hence can never be, to my understanding, practical. 
But I leave the solution to the ingenuity of the author. 

Nosology, or the science of disease, implies three 
things: 1st. There necessarily must be a subject, a 
body to be diseased: 2dly. There must be an agent 
or a cause: And nllw there most be diagnostick signs, 
or disease could not be recognised. 

Although nosology has chiefly for its object a con- 
sideration of the phenomena, yet the subject and the 
agent are involved in the general idea of disease. And 
either the human body cannot be a subject of nature, 
or the agents are not productions of nature, or the phe- 
nomena can take place without a subject or an agent; 
otherwise I expect to show that the science of disease 
is a science of nature. 

That science is said to be a natural science, the 
scope, object, and tendency of which are, to treat of those 
subjects and agencies that strictly are physical. The 



Xll INTRODUCTION. 

business of natural history, is to record the things and 
operations of nature. 

A science is termed a natural science, in contradis- 
tinction to the science of the mind; to the science of 
general or particular state polity; to the mathematical 
or demonstrative science; to the tactical or maritimal 
science. Tacticks and navigation, however, are rather 
arts than sciences. To the above enumeration might 
be added the forensick and medical sciences; as far 
as the latter has a practical interpretation, however, it 
is generally styled the "art of healing" Although in 
a more general acceptation, the medical science i- 
nominated the science of healing; but not so properly. 
For assuredly, as relates to practice, medii ine is an art, 
puivly tentative; a matter of experiment solely. 

It is conceded on all hands, that if it can be u 
Wished that the science of disease is a branch of natu- 
ral history, it follows, of course, that in character and 
diagnostick, it is fixed and determinate. 

The laws of animal life, on which depend the struc- 
ture and economy of the animal body; by which, at 
first, the whole organization was laid out, and by which 
it is reproduced and sustained, are natural objects; ob- 

9 of which the science of nature delights to 
course. And it is in these principles of life that the 
susceptibilities reside, on which the morbid agents act. 
Can natural history treat more properly of any Nil 
than of the structure, the life, in its sensible pheno- 
mena, and of the susceptibilities of the human body i 



INTRODUCTION. Xlll 

This structure, this life, and these susceptibilities, are 
intimately concerned in disease. And surely, so far, 
disease is a subject of a branch of natural history. 
And, so far, must be as unchangeable as the principles 
of life themselves. 

But the principles of life on which morbid agents 
exert their forces and powers, are not more the sub- 
- of nature than the agents to the operation of 
whirl i are finally to he traced the disease. Nor can 
those agents exert their influence, except through pro- 
perties natural and intrinsick to themselves as agents. 
We cannot conceive a fundamental change in the pro- 
perties of an ag^nt, but with a radical alteration of the 
thing itself. And upon such alteration it ceases to be 
an agent. 

Granting that the subject and agent are the objects 
of natural history, I propound the question, what can 
the result or disease be? Can a subject be acted on 
otherwise than through its own capacities? Or an agent 
act by other instruments than qualities intrinsick to 
itself? Is not the disease immediately and necessarily 
consequential on such operation? But still we are told 
that the science of disease is not a science of nature; 
that the phenomena of disease are not the proper ob- 
jects of natural history! If not the legitimate objects 
of natural history, of what history are they the proper 
objects? Diseases have existed from time immemorial, 
and we have histories of diseases. Shall we denomi- 
nate such histories medical histories? 



XIV INTRODUCTION. 

Medical histories are complex, not simple; and in 
strict propriety, are more annals of the efforts of human 
skill and art for the removal of disease, than of disease 
itself. Had there been no medical profession, the pen 
of the historian would have transmitted down to us the 
narrative of disease. 

Nature, in her general scheme, is uniform; otherwise 
ruin would invade the universe. But one part of nature 
may fall into collision with another part, and the regu- 
larity and uniformity of particular laws be disturbed. In 
lifeless nature, we style such disturbance and in - 
larity disorder, or disarray. In enlivened nature, wo de- 
nominate such disturbance of function, or alteration of 
structure, disease. And although disease be not a part 
of the natural healthy functions of the body, yet it must 
be viewed as the natural result of agents acting on these 
functions. 

A column of electrick fluid passes from a cloud 
electrified plus, to one electrified minus; or a column 
descends from a cloud to the earth: the atmosphere is 
greatly ratified; a sudden evaporation from the cloud 
is produced; and by this sudden evaporation, the tem- 
perature of the cloud is depressed, and a portion of the 
water of the cloud is rapidly changed, by the sudden 
and great loss of heat, from a vaporous to a solid state. 
Irregular masses of ice are formed, which, partly from 
the resistance of the air down through which they are 
precipitated, and partly from laws proper to themsel 
constitute hail, or congealed bodies. These, by their 
own superior grarity, and the impulse received from 



INTRODUCTION. XV 

the violence of the wind, in their descent, injure and 
destroy trees, brutes, and men. 

Here, from a simple exchange between the clouds, and 
a descent to the earth, of an electrick column, we per- 
ceive the most disastrous consequences. The contu- 
sions in some, and the deaths of other animals, are 
equally with the prostration of the forest, subjects of 
natural history. And it is natural science, that by its 
lamp, conducts curious inquiry from the last effect to 
the first cause, explaining to (he eye of enlightened 
intelligence, this awful but grand phenomenon. How 
simple the philosophy of the formation of hail, during 
the days of the highest temperature — a sudden evapora- 
tion.* 

The marsh effluvium, wherever found, and however 
produced, never from (uiimal matter, is an agent brought 
into existence by a certain combination of natural atoms 
by laws proper to these atoms. Or it is an agent from 
some simple source and indecomposable. Its nature is 
inscrutable. But, compound or simple, it is furnished 
from nature's stores. 

This effluvium is poisonous to human life, and pro- 
duces disease. And to whatever period of the history 
of its operations the eye of observation is directed, the 

* I wrote an essay on this interesting phenomenon between ten 
and fifteen years ago, for the Maryland Society; in which I at- 
tempted to prove that the formation of hail in hot weather was 
wholly attributable to a sudden passage of electrick fluid from cloud, 
to cloud, or to some other body. 



XT1 INTRODUCTION. 

same effects will be perceived under the same circum- 
stances. Nor in the opinion of the medical philosopher 
is there any fact more certain, or better established, 
than that men living within its range, will be < If 
with diseases of the spleen and liver; with diarrhea, 
intermittent, remittent, and yellow fevers. 

How is this fact established, so as to be made a thing 
of uniform belief? Is it from individual observation, or 
the general history of the effects of this poison? Surely, 
from general and acknowledged liisi 

This effluvium, whether in the East Indies or M 
Indies, in Greece or Italy, France or Am > the 

same; the human body and economy are in principle 
and general attribute the same. Thus it occu 
wherever the poison is evolved in given quantities, \\» 
see the swollen spleen, diseased Ii\er. bilious coliek, 
morbid secretions of bile, with all their rnanoqni n 
sick stomach, diarrhea, dysentrriek phrnomena; inter- 
mittent, remittent, and yellow fever; and these modifi- 
cations under various incidental circumstain 

The variety in the effects of this effluvium on the hu- 
man body, is not greater than in the conditions under 
which water is found; sometimes of ice, or snow, or 
frost, or fluid, or vapour, the productions of incident or 
circumstance. But yet water modified, as it may be, is 
the same, and an object of natural history. The effects 
of the marsh poison are equally uniform. In the same 
intensity, and under the same circumstance, and on the 
same excitability, the phenomena will be without va- 
riety, and is equally a subject of natural science. 



INTRODUCTION. XVU 

For a physician to say that disease, in principle and 
nature, is alterable, is to inform the world that he is to- 
tally ignorant of the science and history of disease, and 
of what he undertakes to speak. 

We at times, it is true, have a new disease to come 
in upon us. And what is this, but a discovery that our 
previous scheme of science did not embrace a know- 
ledge of all the possible morbid effects, or causes ade- 
quate to the production of disease ? Or indeed, that 
some new agent or combination had come into opera- 
tion. But such would be from the store-house of na- 
ture, or her plastick, creative power. But this is not 
phange; it is only an addition to the old stock, nume- 
rous enough ahead) ! 

That one and the same disease can arise from this 
cause to-day, and that cause to-morr >u. is unphiloso- 
phick and absurd in the extreme, and in the face of all 
the facts of history, and analogies of nature. As I have 
advanced, I believe, somewhere else, there is nothing 
better settled in science, than that no simple effect can 
be produced by any two or more causes distinct in their 
nature. Every simple effect must be referred to some 
simple cause, aided as it may be, by incident and casu- 
alty. 

What I have said of marsh effluvium, I might, with 
equal propriety, repeat of the various animal, vegetable, 
and mineral poisons. They are all from the great work- 
shop of nature, and all their effects on the human body, 
necessarily consecutive of their attributes. 

a 



XV111 INTRODUCTION. 

I might here refer to other irregularities and disor- 
ders in the physical world ; the tornado, the earthquake, 
the water-spout, &c. &,c. and ask the question — are 
thcw more the productions of natural changes and com- 
binations than the plague, the small-pox, the influenza, 
the canine madness, the mumps, &c? Or are the for- 
mer better known than the latter, in their sensible phe- 
nomena or ruinous effects? But the one is said to be a 
branch of natural history ; the other is a branch of what 
science? Is the tornado, the earth-quake, the water- 
spout, more constant and distinctive in their effects, 
than the small-pox, siphilis, the canine madness, &x. 
&c, in their diagnostick symptoms? The former and 
the latter both vary in degree. 

The learned professor has given to the world a no- 
sology; but to what end or purpose, if disease be not 
regular in its sensible signs, the professor has, in so 
laboured a manner, spread himself before the world, I 
cannot conceive. If the animal machhwry, the human 
structure, be so alterable and altered, and the symptoms 
of disease so irregular and inconstant as to make the sci- 
ence of disease a matter of speculation, what benefit or 
advantage can accrue to the profession from any efforts 
at distinct enumerations of character? 

The diseases of the subsequent year may not be 
known by the phenomena of the precedent, and those 
of New-York may never appear in Baltimore, Philadel- 
phia, or Lexington. Where, and what then are the 
ad antages derived from spending a great deal of money, 
and wasting much more valuable time, by attendance on 



INTRODUCTION. XlX 

lectures in New-York, for two or three seasons? If dis- 
eases do appear, and they will not fail to annoy the 
world, they may manifest themselves under new forms. 
How unavailing our knowledge and our reading! For- 
mer realities have become unreal, and our science va- 
nishes like the dream of a feverous moment. Of all 
men in the world, the nosologist should be the last to 
utter a word against uniformity and regularity of diag- 
nostick and pathognomonick in disease. 

The able and ingenious professor offers to the world 
a nosology, and in the very preface assures his reader, 
that the literary performance to which his attention is 
invited, is entitled to but little consideration. For if di- 
agnosticks are not constant and determinate, it may be 
insisted that the most laboured writing is vain, and the 
most sedulous perusal equally vain. But the Doctor de- 
clares his to be a " practical nosology." I would much 
rather see a scientifick nosology ; a nosology founded on 
nature and accurate observation. In my estimation, 
those distinctions, in any nosological method, which are 
established for the sake of practical convenience, are 
slightly to be valued. Nosology cannot be supposed to 
take its character and form from practical convenience. 
On the other hand, practice must always derive its les- 
sons from that order of sensible characteristick signs 
which nature presents, and, by the aid of which alone, 
we can form any rational idea of the condition of parts 
or the whole body. 

Were a physician inadequate to discriminate a re- 
mittent fever from a small-pox, or a condition of mea- 



XX INTRODUCTION. 

sles from a pleurisy, or an apoplexy from an hydropho- 
bia; or were a surgeon unable to distinguish a wen from 
a cancer, or a varix from an aneurism, he would pro- 
voke the contempt of every man who had ever looked 
into a medical book. But yet diagnosticks are not de- 
terminate! 

I ask again, if the science of disease or nosology be 
not a branch of which natural history treats, will the 
learning of Dr. Young, or Mr. Good, or any other 
learned gentleman, inform the profession to what his- 
tory it may be referred ? 



ADVERTISEMENT. 



In the year 1806, I was appointed to deliver the Lec- 
tures founded by Dr. Theodore Gulston ; and having 
chosen the Yellow Fever as my subject, and prepared 
myself to discharge this duty, I found it would be im- 
possible to read what I had written, within the time 
allowed for these lectures ; and considerable parts of 
it were, therefore, separated, and laid aside. These 
have been since restored, and some facts have been 
added, which had not then occurred. I have, more- 
over, subjoined three chapters on Typhus, Dysentery, 
and the Plague, which seemed fit to be connected or 
contrasted with the Yellow Fever, or with each other. 
I have also added eight Appendices, to confirm or illus- 
trate particular positions, contained in the Essay on 



XX11 ADVERTISEMENT. 

Yellow Fever : and as only the first two parts of this 
Essay were printed, when I determined to embark for 
Jamaica, I requested my father to superintend the re- 
mainder of the volume. 

There are no diseases which affect mankind so ex 1 - 
tensively, or produce so much mortality, as some of 
those which occupy this volume ; and as very opposite 
opinions are entertained, respecting their origin and 
contagious power, real or supposed ; and as this opposi- 
tion of opinions is disreputable both to the science and 
professors of medicine, and incompatible with the best 
interests of mankind, I have endeavoured to remove all 
doubt and obscurity from these important questions, 
and place them beyond the reach of future controversy. 
How far this endeavour will prove successful, time 
must discover. But in regard to the Yellow Fever. I 
am persuaded that I shall have done more than enough 
to convince ever} 7 candid and judicious reader, that it 
possesses no contagious power ; and that a considerable 
part of the facts and arguments which I have employed 
for this purpose, might have been spared, had I not 
been also anxious to convince, even the most prejudice^ 
on tills subject. 



ADVERTISEMENT. XXili 



I know, indeed, that many of these facts, and argu- 
ments, have been already noticed ; some by one, and 
others by different writers ; but as in these ways, they 
have failed to produce that general conviction, which is 
most desirable, I have thought I might render an im- 
portant service to mankind, by so collecting and arrang- 
ing the proofs, and reasons connected with this question, 
as would best fit them to elucidate, and support each 
other, even if I had not been able to add any thing 
new?, and valuable from my own stock. 

I know, also, that I have been anticipated in several 
of my most important conclusions ; but as I was led to 
them, rather by own train of reasoning, than by defer- 
ence for the opinion of others, however respectable, I 
may in regard to these, say with Montaigne, " Que la 
verit'3, et la raison sont communes a un chacun, et ne 
sont pas plus a qui les a dites premierement, qu'a celui 
qui les a dites apres." I have, however, commonly 
mentioned those writers, by whom conclusions similar 
to mine were first advanced, (so far, at least, as they 
are known to me) for the purpose of giving them all 
due credit, and also to confirm my own opinions, by 
their authority ; and, in my quotations, I have, with 
two or three unavoidable exceptions, always referred 



XXIV ADVERTISEMENT. 

to the particular pages of the several works whence my 
extracts were taken ; so that my readers may be able 
to ascertain the accuracy with which they have been 
made. 



AN ESSA\ 



OX THE 



DISEASE CALLED YELLOW FEVER, $c. 



PART I. 



APPELLATIONS OF THE YELLOW FEVER. 

The Fever which is to form the chief subject of my inquiry, 
has been called Typhus icterodes, by Sauvages, and Typhus 
cum fla\cdinc cutis, by (ulltn; it is generally known, in this 
country, by the name of Wllow Fever] among the French, 
by the names of Maladie de Siam, and Fievre Matelotte; and 
among the Spaniards, by those of Vomito Prieto, and, accord- 
ing to Corral and Ulloa, Chapetonada. 

The title bestowed by Sauvages is improper, because the 
Fever in question (independently of any discolouration of the 
skin) does not accord with his own definition of Typhus, and 
also because, as will be proved hereafter, it is not connected, 
at least not generally, with any morbid state cither of the liver 
or of the bile, nor with any permanent obstruction to the pas- 
sage of that fluid into the duodenum, — causes to which icterus, 
or jaundice, is commonly refen-ed. Dr. Cullen may have 
been, in some degree, aware of the latter objection ; and lie 
may. oji that account, have been induced to lay aside the 
epithet of u Ictei*odes. M used by Sauvages, and to substitute 
for it the words " cum flavedine cutis," in his designation of 

4 



26 

the disorder : but even these, as well as the English epithet of 
"Yellow" Fever, are objectionable, because they draw the 
character of the Fever from a symptom w hich is very often 
wanting, even in the most severe cases of the disease, and 
which certainly is not always of high importance when it does 
occur, very many persons having recovered after being re- 
markably yellow . 

The term of " Vomito prieto," or " black vomit," is likewise 
objectionable, because this symptom does not occur in a very 
large proportion of the pei*sons who are attacked by the Fever 
now spoken of; it is, moreover, certain, that neither*' the 
yellowness of the skin, nor the discharge! of a dark-coloured 
matter by vomiting, nor even the existence of both these symp- 
toms:): in the same patient, is peculiar to that disea- 

• Dr Lin J mentions (at pages 188, 198, &c. of his Essay on the health of 
Seamen) the existence of a fever at Portsmouth, on board of several ships of 
war lately returned from Louisbourg and Quebec, "which went commonly 
under the denomination of the Yello-w Fever, from the sick often becoming 
yelfow." This was clearly a different disease from the Yellow Fever of hot 
climates. 

f See page 30, of " Surgical Observations on the constitutional origin and 
treatment of local Diseases," by John Abemethy, Esq for an instance or black 
vomit iu another disorder. 

t One instance will suffice to show, that those two symptoms are some- 
times combined in other diseases. Dr. William Stark, respectable for his 
accuracy, and zealous pursuit of knowledge, in his valuable Clinical and 
Anatomical Observations, (" the materials of which," as he tells us, " Wi 
collected at a great hospital," which it is well known was St. George's Hos- 
pital, London, where it will not be suspected that cases of Yellow Fever 
were to be found) relates, at ch 1, §. 2, the case of a man who died from 
•* inflammation of the smaller intestines, with effusion of blood," and whose 
bod\ he examined after death. From this case the following lines are ex- 
tracted: " A man ag*>d thirty, unknowing of any cause, was one evening 
suddenly seized with retching and vomiting, which were frequent, day and 
night, ever after." " His skin, became yellow on the fourth day, and what 
h vomited was observed, on the eighth, to be of a coffee-colour." ■ He 
died on the thirteenth day." 



21 

Several writers on the Yellow Fever, who have been sensi- 
ble of the impropriety of the above appellations, have adopted 
others, taken from among the names given to fevers by the 
ancient Greek physicians. In the works attributed to Hippo- 
crates, mention is made of violent febrile disorders, which 
sometimes proved fatal on the fourth day, and even sooner, 
and were attended with incessant vomiting, sometimes of black 
matters, yellowness of skin, and other affections so similar to 
tli me which are frequently observed in the Yellow Fever, that 
1 am disposed to believe that they could be no other disease. 
These fevers are described under various names, such as 

* xotwror Ke.VTaiS'r.? tu0os. iy.Tepo$ Xsivrvpiv QptnTi? vorY)u.x zrx^u &C. 

but as the descriptions are either very loose or very brief, and 
as each of these names is also applied to other very different 
diseases, it is evident that no precise meaning can be affixed to 
them, and that confusion would result from employing any 
one of them to designate the Yellow Fever. 

It is unquestionably of great moment, both for the advance- 
ment of science, and the prevention of dangerous errors in 
practice, that disorders should not be arranged under impro- 
per titles : and of all titles, none can be more improper, or 
tend more to embarrass inexperienced practitioners, than such 
as are borrowed from certain symptoms, which, like the yel- 
lowness of skin, and the black vomit, besides being wanting 
in the great majority of patients, do not, in general, make 
their appearance, when present, till towards the close of the 
disease. I hope, therefore, that the disorder, of which I am 



♦ For y.«yo-05. see Lib. <le judicat page 54, line 54 of Foesius's Hinpocr.ites, 
Geneva, 1657 ; and Lib. 1, de Morb. Vulg\ Sect. 7, p, 954 D. : for *«wc-<y^, 
Lib. de Affect, p. 519, 1. 21 : for tJ^o 5 . Lib- de intern. Affect p 553, I 6.: 
for Ule^. Lib de Morbis, p. 49>, 1. 6; and Lib. de intern. Affect, p. 551, 
1. 8: for XetTv^tn Lib de Morb. r>. 467, 1 10 : for Qpiuri^ Lib. de Affect? 
p. 518, 1. 1\ . and for vot^x sret^u, Lib. de intern. Affuct.p. 559, I. 14-. 



28 

to treat, will, ere long, receive a more appropriate name than 
any yet bestowed upon it; but I must leave to others the 
task of proposing one, and content myself with that of Yellow 
Fever, since it is, at present, in general use. I beg, however, 
to observe, that if it be allowable to apply to a disease, affect- 
ing the whole system, a name which designates only one of its 
symptoms, the terms of causus, or of ardent Fever, seem to be 
the most eligible of all the appellations that have been bor- 
rowed from the ancients, and given to the Fever here treated 
of; because the excessive heat of the skin, and indeed of the 
whole body, is a symptom which occurs not only very gene- 
rally, but also very early in the disease, and jefjuii-es particu- 
lar notice for the successful treatment of the malady ■ so that 
either of the above names, especially the latter, is well adapted 
to direct the attention of the practitioner, however inexj>eri- 
enced, to an important point of practice, and is not liable to 
mislead him in other respects, or to occasion uncertainty or 
delay as to the management of the patient in the first stages 
of the Fever. It appeal's to have been upon similar grounds 
that Dr. Towne, M. Poissonnier Dcsperrieres, Dr. Moselev. 
and Dr. Fowle, have app l i e d the one or the other, or both, of 
those names to the Yellow Fever. 

Befofe I proceed to describe the appearance of this im 
I shall briefly notice the indiscriminate mode in which the 
term Yellow Fever has been employed ; a subject not unim- 
portant in itself, since it is probably owing to a want of pre- 
cision in the use of that term, that so much ambiguity has 
prevailed, even to the present time, concerning the nature of 
the disease. The truth is. that in those countries in which 
the temperature of the atmosphere is usually heated, during 
certain seasons, to 85 , or more of Fahrenheit's thermometer, 
in the day time, all febrile affections, however produced, have 
a tendency, in consequence of the action of heat on the human 
body, to assume the violent and dangerous form which is 



29 

generally considered as characteristic of the Yellow Fever. 
Thus, the fevers which sometimes originate from intoxication, 
and other excesses, from taking cold, or from fatiguing exer- 
tions of body, while exposed to the sun, or strong agitations 
of mind, are, in those hot seasons liable to be accompanied 
with the same severe and fatal symptoms which occur in the 
terrible Fever that occasionally attacks a great part of the 
population of certain towns situated in warm latitudes ; 
and from this resemblance, the term Yellow Fever has been 
equally applied to Fevers, which are strictly sporadic, and 
comparatively rare, and to Fevers truly Epidemic* But, 
although the same symptoms be observed in the Sporadic, and 
the Epidemic Yellow Fever, the course of these is not exactly 
similar, and their causes are totally different. The Sporadic 
Fevers are always, I believe, of the continued type, and are 
brought on by certain affections of the body and mind, operat- 
ing only upon a few individuals ; whereas the Epidemic Fever 
almost always manifests a disposition to remit, unless the 
speedy death or recovery of the patient precludes a second 
paroxysm ; and it arises from causes of a general nature, 
such as are capable of operating on a considerable number of 
persons at the same time. The causes of the Sporadic Yellow 
Fever are so well known, that it is in the power of almost 
every individual to preserve himself from its attack ; but 
those of the Epidemic Fever are still involved in so much 
obscurity, and placed so little within our power, that neither 
human ingenuity, nor patriotick zeal, with their most perse- 
vering efforts, have as yet been able to hinder its appearance, 
or perhaps materially to check its ravages. This is, there- 
fore, the most formidable and interesting to mankind ; and it 
will, for this reason, form the chief object of my present in- 

* By the term Epidemic, I understand simply a disease prevailing in an 
extraordinary degree, without any reference to contagion, which I do not 
consider as being- essential to an Epidemic. 



30 

quirv . A great part of the subsequent observations, however, 
concerning the symptoms and the treatment of the Yellow 
Fever, will, I think, be found equally applicable to the Spo- 
radic and to the Epidemic disease. Both have, indeed, been 
described by so many writers of great eminence, that it will, 
I hope, not be deemed improper in me to abstain from giving 
a minute account of all the various symptoms of this Fever in 
its several forms, and to confine myself to those only which 
are of most importance, as indicating the nature of the dis- 
ease, and the parts principally affected by it, together with the 
proper means of obviating, or removing those affections. 

The progress and violence of the Yellow Fever differ great- 
ly, according to the force of its cause, the rigour and ei 
bility of the patient, and the season of the year. When it 
prevails epidemically in hot climates, and attacks young and 
robust men. lately arrived from temperate regions, the di^<»r- 
der.commonly appears in its most Aggravated form. In this 
the patient first complains of lassitude, n — . slight 

sensations of cold and nausea, which symptoms are soon 
reeded by strong arterial action, intense heat. Bashi ng of the 
face, redness of the eyes, great pain and throbbing in the head 
and in the eye-balls, uneasiness and pain in the stomach, op- 
pression of the praecordia, a white fur on the tongue, and a 
dry, parched skin, with a quick, full, tense, and generally 
strong pulse, though it is sometimes oppi*essed and irregular. 
These symptoms are speedily accompanied by frequent effort! 
to vomit, especially after swallow ing food or drink, \n ith 
discharges, first of such matters as the stomach happet 
contain, and afterwards of considerable quantities \»f bile 



31 

appearing first yellow, and then green,* sometimes tinged 
wkh blood, but, in the progress of the disorder, with matters 
of darker colours ; an increase of pain, heat, and soreness at 
the praecordia, also occurs, with constant wakefulness, and, fre- 
quently, with delirium, more or less violent. This paroxysm, 
or exacerbation, which has been called the inflammatory, 
or the febrile stage, generally lasts thirty-six hours, but is 
sometimes protracted for seventy-two hours, and even longer, 
probably in consequence of either general or local inflamma- 
tion, ( particularly in the brain or stomach) or of i\ -regularity 
in the circulation, which are known to prolong the paroxisms 
in Fevers of Type. 

A remission then occurs, in which many of the symptoms 



♦ The green colour of the bile, which is very frequently brought up by vomit- 
s been attr.buted, by some writers, to a morbid condition, or action 
of ih. livvr, or gall-bladder It would probably, however, be more just to 
atti bute it to a spontaneous, and, as it n ay be called, chemical chang , 
the bile itself undergoes in the duodenum and stomach, while these viscera, 
being debilitated by disease, or by the operation of certain m d cines and 
particularly of emetics, no longer possess the powvr of pr> venting-the matter 
which they contain from acting chemically on each other, and forming de- 
compositions and new combinations. This power of the stomach, which has 
b.en called by Dr. Fordyce its governing power, will be particularly not.c d, 
13. Stc. in trea'ing of the symptoms which denote a putrescent state 
of th fluids. It is well known, tha<. the feces of infants, although yellow 
i ikied, (which is the proper colour of the bile m.xed with them) fre- 
quently become green after some time ; and, in addition to this, 1 may ad- 
duce the following tact from page 206, of Dr- Heherden's Commentary de 
morborum historia & curatione. " Cujusdam icterici urina saturrime fusca, 
paucas horas servata, viridem colorem induit ; quemadmodum interdum fit 
in vomitu bills flavse, cujus color post ahquam moram in viridem mutari 
solet." As acids, when added to bile, change its colour from yellow to 
green, it is, probably, from a m xture w th acescent matters that the bile 
beconvs ?reen with.n the intestines : and this is the opinion which the late 
Dr. John Hunter aUo entertained ->n the subject— See page 129 of his Ob- 
servations on the diseases of the Armv in Jamaica. 



32 

subside, so as often to induce a belief that the Fever is at an 
end, and recovery about to take place. Frequently, how ever, 
the foundations of irreparable injury to the brain or stomach 
have already been laid in the former paroxysm, and in such 
cases the remission is short and imperfect. During these re- 
missions the pulse often returns apparently to the condition of 
health, the skin feels cool and moist, and the intellect, if pre- 
viously disturbed, sometimes becomes clear: sometimes, how- 
ever, the patient remains in a quiet and stupid state, a symp- 
tom generally denoting great danger. Another sign of dan- 
ger, as denoting a very morbid condition of the stomach. i> 
the renewal of the efforts to vomit when pressure is made on 
that organ, or food is swallowed. After a certain interval, 
this remitting stage is succeeded by another, which may he 
called the second paroxysm, and which probably would appear 
as a renewed exacerbation, if the \iolent effects of the find 
had not almost exhausted the patient's excitability, and in 
conjunction with the extreme depression of strength which 
Usually attends inflammation of the brain or stomach, ren d er ed 
him nearly unsusceptible of those morbid actions which arc 
necessary for that purpose. In this latter stage, then, instead 
of great febrile heat, and strong arterial action, the warmth of 
the body, and the frequency and strength of the pulse, are 
often less than when the patient w as In health : hut frequent- 
ly the pain and heat in the stomach become excruciating, with 
incessant strainings to vomft. which, in most of the fatal ca- 
ses, are followed by hiccough, and repeated discharge 
matters resembling turbid coffee, more or less diluted, or the 
grounds of coffee, and also by evacuations of similar dark 
matters from the bowels. Here it is to be observed, that w hen 
these symptoms occur, (indicating a violent affection of the 
stomach and bowels,) the patient is, in general, sufficiently in 
possession of his intellects to know those about him, and to 
give distinct answers to questions made to him, although his 



33 

excessive Weakness often renders him incapable of mental ex- 
ertion, and his inability even to raise his head, may induce the 
appearance of coma. In those cases, however, in which the 
brain has suffered greater injury than the stomach, the retch- 
ing and the black vomit, just described, do not so commonly 
occur, but instead of them, low muttering, or coma, with 
convulsions of the muscles of the face, and the other parts 
of the body, supervene. About this time, also, the tongue and 
teeth arc covered with a dark brown fur ; yellowness of skin 
and petechia make their appearance ; the urine, when passed 
has a putrid smell and dark colour ;* the faces likewise be- 

* Of the many authors who have treated of putrefaction in fever, the late 
Dr. Ceorge Fordycc- seems, in his investigation of that subject, to have ap- 
proached most nearly to the truth. His reasoning thereupon, which will be 
found at length at page 71 of the first part of hi» third Dissertat on on 
Fever, and at page 151 of his Treatise on D.gestion, may be summed up as 
follows : 

The Creator, as one of the means of destroying and removing the remains 
of the successive races of animals and vegetables as they become extinct, 
which otherwise must have accumulated on the surface of the globe so as 
to afford no space for new generations, has ordained that dead animal and 
vegetable matter should be subject to certain processes called fermenta- 
tions, and terminating in putrefaction. Now every circumstance which would 
cause a rapid putrefaction to take place in the dead body of a man, is con- 
stantly applied to the living body ; viz. a warmth of nearly 100 degrees of 
Fahrenheit's thermometer, the contact of atmospheric air, and motion; and 
although no chemical circumstance has been discovered in the body of a 
living man that is capable of hindering such putrefaction from taking place, 
nevertheless the body of a living man has no appearance of putrefaction : 
and hence he concludes, necessarily, that there is in the life, independently 
of all other circumstances, a power of preventing putrefaction. Thus en- 
dowed, the living body is able to preserve, from the fermentations above- 
mentioned, not only its own solids and flu ds, but also, when in health, the 
extraneous matters, as aliment, which it contains ; and thus, when the living 
power of the stomach is strong, the food thrown into that viscus will be 
perfectly digested ; but, when the organs of digestion are weak or disord-red, 
•r when food is given to an animal which is not adapted to its organs of di- 

5 









34 

come most offensively putrid ; haemorrhages sometimes take 
place from the nostrils, gums, and various other internal sur- 
faces ; there is, in some patients, a suppression of urine, in 
others an involuntary discharge of it, and of the faeces : the 
pulse becomes feeble and intermits ; the breathing is laborious, 
portions of the skin assume a livid colour, the extremities 
grow cold ; and life is gradually extinguished. 
This is a general outline of the Yellow Fever, when it ap- 

gestion, a greater or less portion of that food is not governed by the stomach, 
but runs into the fermentations which would arise, if it had been in the sane 
chemical circumstances, out of the body. It seems to be upon the same 
principle (viz the defect of the governing power, as Dr Fordyce has not 
inaptly styled it, of the organs, or vessels, of" the body over the substances 
the> contain) that we are to explain why. in certain morbid conditions, the 
faeces, the discharges from the vagina and from wounds or ulcers, and also 
pus, in the lungs, or other parts, the urine, and even the blood, which has 
been itself supposed to possess a living power, become putrescent. •• The 
putrescency of the blood," (says Dr. Fords ce, at page 285 of the 1st volume 
of the Transactions of a Society for the improvement of Medical andChirurgi- 
cal knowledge) "is ihe effect of the depression of strength ; for it happens only 
when there is great depression of strength ; and wh.-n such depression arises 
in any other case, the same progress towards putrefaction is always ob- 
served." It is a confirmation of the above opinion, that, in most of those 
cases of injury to the spine, or disease of the bladder, in which this vise us 
loses the power of contraction, it also soon loses its governing power, and 
the urine is voided in a putrescent state, like that voided in severe cases 
of tlvcr. 

Two distinguished modern physiologists have stated it as their belief, that 
the stomach and intestines had, under certain circumstances, a power of 
secreting air ; but even their authority has not removed the objections to 
th.r. opinion which appeared to me to exist ; and the generation of the air 
in question will, perhaps, be more satisfactorily explained by supposing that, 
under sueh circumstances, the governing power of those viscera, is, in a cer- 
tain degree, impaired, in consequence of which chemical decompositions of 
the matters contained in them begin to take place, and air is thereby eTolved 
It is not necessary to remind the reader of the volumes of various gazes 
which c~n be extneat d by chemical agencies, from even small masses of 
most of the substances usually existing in the alimentary canal. 



35 

pears in its most violent form ; and in this form it some- 
times proceeds with so much rapidity as to destroy the 
patient on the third or fourth day, or even sooner. But 
the disorder frequently appears in a milder form at first ; 
the course being protracted into several paroxysms, shor- 
ter at first, and followed by more distinct remissions, but 
afterwards increasing in violence and in duration, when the 
disease terminates fatally. In these cases, death usually hap- 
pens between the seventh day and the fifteenth. 

The features, which are the most remarkable in this dis- 
ease, are the affections of the head, of the stomach, and of the 
skin ; and I therefore propose to offer some observations on 
each of them. There is great reason to believe, botli frem 
the symptoms, and from the frequent examinations which 
h;i\e been made after death, that most of those, who die of 
the Yellow Fever, arc destroyed in consequence of some irre- 
parable injury having occurred either in the brain, or in the 
stomach. It seldom happens, however, that these organs are 
both mortally injured in the same subject ; more commonly, 
one of them only is dangerously affected. I do not here mean 
to atom, that there have been cases of the Yellow Fever, in 
which a fatal affection of the head had supervene^, without 
any disorder of the stomach ; or cases in which the stomach 
was much diseased, while the brain continued in a sound or 
healthy state ; — for I believe, on the contrary, that these or- 
gans jointly suffer more or less in every case and species of 
Fever ; but, according to my experience, and that of se\eral 
very respectable practitioners, with w bom I have conversed on 
the subject, those patients in the Yellow Fever, who die from 
an affection of the head, generally perish early in the disease, 
and with less vomiting, especially of blackish, or dark-colour- 
ed matters ; whereas, on the other hand, those in whom this 
last symptom greatly predominates, are usually found to have 
their mental faculties clear, though often much weakened ; 



36 

and they seldom expire before the end of the fourth, or the 
beginning of the fifth day. 

DISSECTIONS. 

When flie bodies of patients, in whom the affection of the 
head formed the principal feature of the disorder, have 
inspected after death, the integuments of the brain ha 
rally been found more or less inflamed, especially near the 
temporal bones ; the vessels of the dura mater, and of the pia 
mater, were not unfrequently observed to be verj turgid with 
blood, which moreover was sometimes exti <l. Effu- 

sions of a watery fluid also have o< < asionallv tee* Bee* over 
the surface of the brain, or in vesi< It ^ between the pia mater 
and the tunica arachnoidea. hi some cases, the integuments 
have been so firmly attached to each other, and to the brain. 
that, in attempting to raise, or separate them, apart of the 
substance of the brain Iras been torn up. The volume of the 
brain is often increased, and the substance of it is, in some 
instances, more firm than usual : when cut* the vessels distri- 
buted through it, have been so distended with blood, that the 
medullary part has immediately become thickh spotted with 
red points, owing to the oozing of blood from the di\ idee! 
sels ; and it was not rare to find that some of those vessels had 
been ruptured, and that blood had escaped into the subst 
of the brain. The ventricles have usually contained water, 
frequently of a yellow colour, and were, in somo quite 

filled with it. The plexus choroides has often been loaded 
with blood. 

Such is the disorganization which careful dissectors ! 
uniformly detected, in a greater or less degree, in those ca- 
ses of the Yellow Fever in which the predominant symptoms 
indicated a severe affection of the head. It accounts suffici- 
ently for the occurrence of those symptoms, and for the fatali- 



37 

ty which so often attends them, as well as for the derange- 
ment of mind, the loss of memory, the impaired state of the 
sight, and other senses, and the extreme feebleness of the 
limbs, which are the frequent consequences of this disorder in 
those who escape with life ; and from which they sometimes 
recover very slowly. 

Those cases of the Yellow Fever, in which the stomach is 
principally affected, are next to be considered. This organ 
appears to be the most universal and important of all the vis- 
cera, and that which is the most indispensably necessary to 
animal life. Some animals are organised with so much sim- 
plicity as to have no visible brain, heart, or lungs ; other ani- 
mals, with cold blood, which are endowed with these organs, 
will live, and even move, for a considerable time after being 
deprived of them : but no animal is formed without a stomach, 
nor would any one he capable of supporting life, perhaps for 
even ft very short time, after that riseus was destroyed. — 
There is. indeed, no other animating viscus discoverable in 
Zoophytes, Ilydatides, Polypi, kc. though they are all capa- 
ble of muscular motion and sell-propagation. In the more 
perfect warm-blooded animals, which possess other vital or- 
gans besides the stomach, this last always sustains a distin- 
guished part in the general system, by its important functions 
and associations. When it is in its healthy state, every other 
part of the body feels its salutary and invigorating influence; 
and when, on the other hand, it languishes or suffers, they all 
participate in its derangement. Ardent spirits, Opium, 
./Ether, tVc. when swallowed, produce powerful effects in eve- 
ry part of the body, long before they can ha\ e passed beyond 
the stomacli ; and a few ounces of strong Laurel-Water* occa- 

* Fontana, sur les poisons, vol. ii p 125. "Si on donne cette eau (de 
Launer-Cerise) en grande quantity auxanimaux, ils meurent prcsque clans 
l'instant sans convulsions, toutes les parties dc leui*s corps £tant relach^es, 
& dans 'laffaisement. 



38 

sum almost instant death, upon reaching that viscus, without 
any struggle or appearance of re-action. But this intimate 
and extensive connexion of the stomach with other parts of 
the body, and its great irritability, subject it also to be injur- 
ed and disorder by every thing which occasions injury and dis- 
order to them. Thus it exhibits marks of inflammation in an- 
imals killed by the bites of venomous serpents, and of rabid 
animals, and by other poisons externally applied ; and it is al- 
ways, in some degree, affected by attacks of Fever, in which 
loss of appetite, aversion from food, and inability to dig* 
occur with not less certainty than any other febrile symptom. 
But the Yellow Fever is almost invariably attended by murks 
of disorder in the stomach, much more decided than these, — I 
mean nausea, followed b\ frequent vomiting, even in the early 
pwi of the disease, and by the discharge of considerable quan- 
tities of bile, — a discharge which appears, in t 
be caused solely by the efforts to vomit, in the same ma 
as in sea-sickness, and other affections, in which tli. 
tion of bile, and even the increased secretion of that fluid, 
(which violent vomitings are believed to occasion] are strreij 
a consequence,* and not a cause, of the disorder. These uidi- 



* Dr. G. Fordyce has properly noticed, in his valuable Dissertation on 
Simple Fever, (page 94,) the error of a common opinion, viz — that " re- 
dundancy of bile constitutes an essential part of the attack of Fever," which 
opinion has been formed, because bile is "conspicuous from its colour, taste, 
and smell; while the gastric, pancreatic, and other juices, as they are not 
very conspicuous for their sensible qualities, have not been taken into the 
account." " If the pancreatic juice had been blue, (continues he,) and had 
any particular taste or smell, and the bile had been colourless, insipid, and 
inodorous, or as much so as the pancreatic juice now is ; in that case, what- 
ever has been said of the redundancy of bile, as being an essential part of 
the attack of Fever, would have been said of the pancreatic juice. — See also 
the Aote, at page 46r, of Dr. Clarke's Observations on the Diseases of Long 
Voyage*. The idea of an increased secretion of bile in the Yellow Fev 



39 

cations of a morbid affection of the stomach in the Yellow Fe- 
ver, are accompanied with others, affording similar evidence 
of the state of that organ, particularly excessive thirst, acute 
pain, and burning heat in the stomach, with so great a degree 
of tension and soreness over the epigastric region, that exter- 
nal pressure cannot be endured. As the disease advances, 
these symptoms become more violent, the strainings to vomit 
arr incessant ; and when the termination is fatal, hiccough and 
the black vomit usually supervene. 

When the bodies of those who have died with the preceding 
symptoms have been dissected, the stomach has, in every in- 
stance, as far as either my knowledge or my information ex- 
tends, exhibited very evident signs of inflammation. In some 
. almost the whole inner surface was inflamed ; very often 
portions of the villous coat were abraded, and not unfrecjucntly 
observed floating among the contents of that viscus. Marks 
of inflammation, but less violent than these, have also been 
oftHi seen in the small intestines, especially near the pylorus. 
The inflammation observed on these \ iscera, seems to be of 
the kind denominated erythematir, which is found to affect 
the villous coat of the intestines more frequently than any 
other. This kind of inflammation is apt to spread wherever 
thei-e is a continuity of membrane or of structure ; and as 
such continuity exists through the alimentary canal, the vis- 
. Mearest to the stomach, must be liable to participate in 
the inflammatory affection of the latter. 

THE BLACK VOMIT. 

As erroneous opinions have been entertained concerning both 
the origin and nature of what is called the Black Vomit, it 

in persons living in warm climates, is opposed by Dp John Hunter, upon 
ground* which appear to be just, at page 128 and 316, of his Observations 
on the Diseases of the Army in Jamaica. 



40 



may be proper to state, in this place, some facts and observa- 
tions relating to it. 

From the time of Galen, bile was supposed to be the prin- 
cipal agent in producing intermittents ; and as soon as 
became acquainted with the Remitting Fever of the M est 
Indies, it was generally ascribed to that cause. Dr. To 
who, in 1726, published an account of the Yellow Fever, in 
the name of " Febris Ardens Biliosa," considered it 
truly bilious disorder; so did Hillary, who call " Pu- 

trid Bilious Fever." This idea has boon sinre \ i <ll\ 

adopted, and the matters which constitute what is termed 
Black Vomit have, accordingly, been deemed, by many per- 
sons, to be the product of a morbid secretion of the Liver, or 
else of a morbid change in the bile. That neither of tl 
however, is the case, has been clearly ascertained, h\ 
examinations made upon the bodies of great numbers of per- 
sons who have died of the Yellow Fever, particularly In Dp. 
P. S. Physick,* in Philadelphia. In these dissections, the 
Liver was very rarely found diseased, and even when in that 
state, the disease seems almost always to have been of a 
chronic nature. The alteration from the usual ap] 
of this organ most frequently observed, was a greater 01 
degree of paleness. The stomach, however, wa tantlj 

diseased, if the symptoms, which I have lately mentioned as 
denoting inflammation in that organ, had previously 
The matter of Black vomit (which is commonly found in the 
stomach, but is also found in the intestines when they have 
partaken of the inflammation) was never discovered in the 
Gall-Bladder, the Liver, or any other viscus or cavity. The 
stomach has sometimes been loaded with this black matter, 

* For more satisfactory information to the reader, the paper pf Dr Phy- 
sick, which is alluded to, is given in the Appendix, (ifo ere is 
also added the substance of another memoir concerning the Black Vomit, 
written by Dr. Isaac Cathrall, of Philadelphia. 



41 

while, in the same subject, not only the Liver was ft*ee from 
disease, but the bile in the Gall-Bladder was in its natural 
healthy state; and this has been seen in several cases, in 
which a contraction of the pylorus had completely obstructed 
the passage from the duodenum into the stomach. The matter 
of Black Vomit is, besides, essentially different from bile ; it 
differs from it in colour; for, however dark the bile may ap- 
peal* in its most concentrated state, it always displays a yel- 
lowish, oi- greenish yellow tinge, when spread on a white 
surface, or when diluted ; and this is never observed with the 
matter of Black Vomit. It has also been found that an addi- 
tion of bile to the latter altered its nature so much as to gi\c 
it an appearance different from that which it had before; nor 
could the Black Vomit be imitated by any mixture of various 
proportions of dark-coloured bile, with the fluids found in the 
stomach. It differs likewise, most decidedly, in taste ; the 
Black Vomit being always insipid, when freed from other 
foreign matters, whereas bile can never, by any means, be 
deprived of its intense biterness. In many cases, portion of 
the inner surface of the stomach have been covered with a 
coat of thick blackish matter, and upon removing this coat, 
the parts beneath it, and no other, were found inflamed. The, 
substance thus obtained, was exactly similar to that of Black 
Vomit, and, like it, incapable of being made to adhere again, 
when applied to the same or to any other parts. Hence there 
is reason to believe, that the matter forming this black cover' 
ing, must have been derived from the vessels of the inflamed 
part, especially as it could not of itself have produced the 
inflammation, since it is so perfectly bland, that it has been 
frequently dropped into the eye without exciting any greater 
sensation than pure water. Neither can it be supposed, that 
it could have come from the gall-bladder, or from the biliary 
ducts, (in which, as I have remarked, nothing like it has ever 
been found) or from any part of the alimentary canal, and 

6 



41 

have attached itself afterwards to the stomach, in the man- 
ner in which it is seen adhering, — first, because it has no 
adhesive quality when it has been once detached from the 
surface on which it was found ; — and, secondly, because, 
in some subjects, no such matter was found loose in the 
stomach or intestines, although a very great pari of the 
inner surface of the stomach was. at the same time, co\ 
with a coat of it. At those spots, moreoxer. where the 
villous coat had been abraded, the extremities of an 
have been frequently se cn filled with this dark-coloured mat- 
ter; and collections of the same matter have even keen dis- 
covered immediately under the \illous coat. — ■ situation to 
which it is impossible that any fa tig ■ Batten, which had 
passed into the stomach, could have found access. To I 
facts, which render it incredible that the li\er lias au\ share 
in producing the matter of Black Vomit, I ma) add that this 
vomiting of dark matters ne\er a< -companies Htjmtitis, or any 
other affection of the lner: and that it has seldom appeared, 
so far as I can learn, in any case of the Yellow Fever, in which 
there was not reason to belicw that the stomach was. ar had 
been inflamed. It ma\. therefore, be < uu -Imb-d. that when this 
symptom occurs in the above disorder, it is usually 
quence of inflammation in that rijOUB. 

Some authors, who had adopted a similar conclusion, were 
inclined to consider the matter of Black Vomit as a particular 
morbid secretion, by the inflamed veaaelfl or glands of the 
stomach : but this opinion, if 1 understand their meaning, 
not accord with fact : tor it is to be supposed that the villous 
coat, and the glands beneath it. in the only parts of the 
stomach by which secretion can be performed : and proofs 
have have just been adduced, that the matter in question may 
be formed without the co-operation of that membrane, or the 
glands connected with it, since it has been found in the extiv- 
mities of arteries, and lying beneath the villous coat itself. 



48 

The least objectionable, and, in all probability, the tru« 
explanation of the most common formation of this sub- 
stance, and of the phenomena attending it, seems to be, that 
it is Merely blood which has been effused from some of the 
small arteries, ruptured in consequence of the separation of 
certain portions of the villous coat, and has coagulated within 
the general r;i\ it v of the stomach, or on the surface over which 
it was effused : aud having heen afterwards detached, aud 
triturated by the violent and fivquent contractions of that 
organ, in the efforts to vomit, lias had gfei appearance as a 
coagulum of blood altered, and its colour* darkened by the 
gastric juice, or by some chemical decomposition, either 

♦ Dr. Henry Warren, at page 39, of his Treatise concerning the Malignant 
Fever in Barbadot s», (1740 ) says, " I ought here to observe, that the fatal 
black, stools and vomitings are vulgarly supposed to be only large quantities 
of black bile, or choler; which false notion Seems to be owing to that fixed 
unhappy prejudice that the fever is purely bilious. But let any one only 
dip in a bit of white linen cloth, he will soon be undeceived, and convinced 
that scarce any thing but mortfied blood is then voided, for the cloth will 
appear tinged of a deep bloody red, or purple, of which I have made many 
experiments." 

Dr. Cullen, treating of Hxmatemesis, (See Art. 1017 of his first lines of 
the Practice of Physic,) mentions the m black and grumous appearance" of 
the blood thrown out from the mouth, as one of the signs by which " the 
blood may be certainly known to proceed from the stomach ;" and in \rt. 
1029, Treating of Melaena, or Morbus niger, which consists " in an evacua- 
tion either bv vomiting or by stool, and sometimes in both ways, of a black 
and grumous blood," he says, " it is highly probable that what gave occasion 
to the notion of an atrabilis among the ancients, was truly the appearance 
of the blood poured into the alimentary canal in the manner I have men- 
tioned ; which appearance we know the blood always puts on. whm it hat 
stagnated there f%r any length of time" Blood acqu.res a dark colour also, 
though m general more slowly, when it happens to be effused in other parts 
of the body ; and the brownish tinge, which the fluid in Hydothorax and 
ascites frequently exhibits, seems to be derived from a similar change of 
colour induced in the red globules of blood that had been effused into the 
thorax and abdomen, together with serum and coagulable lymph. 



44 

spontaneous, or produced by the action of the air, or other 
matters contained in the stomach. 

That blood is really punned out into the stomach in tin 
manner just stated, will scarcely he doubted, many respect- 
able* author having affirmed, from their own observation, 
that blood, sometimes red, as if very n<< ntl\ effused, and 
often grumous, is frequently vomited in the Yellow Fever. It 
seems, indeed, impossible that any portion of the vfllow 
could be destroyed, or separated from the other units, without 
occasioning a rupture of the arteries which conveyed blood to 
it, or that an effusion of blood should not immediately take 
place from the ruptured arteries, and continue until some of 
the blood thus poured out had coagulated, either within their 
cavities, or over the adjoining surface, \m prevent the 

effusion of more blood. This is the usual y|>eration of nature 
in all other hemorrhages, and. we \uas presume, that it must 
unavoidably be performed in the CMC before n>. 

* Thus Dr. Hush, at p. 4G, Edinb edit, of his account of the bilious Yel- 
low Fever in Philadelphia, in 1793, says, " there was frequently discharged 
from the stomach, in the close of the disease, a large quantity of grurnous 
blood, which exhibited a dark colour on its outside, and which, I b 
was fr quently mistaken for what is commonly known by the name of the 
black vomiting ;" which last Dr Rush had conceived to be ■ bile in a highly 
acrid state." 

On the same subject, one of the latest of the authors alluded to, M. T N". 
Berthe, Professor in the School of" Medicine, at Montpellier, (who was joined 
with two other Medical Professors of that University, Mess P. L^fabrie and 
V. Broussonet, in a commission sent by the French Government into Spain, 
in 1^00, to observe and report upon the Ytllow Fever, then prevalent in 
many parts of that country, and who has since published the result of the 
information collected by that commission, under the title of " Precis Histori- 
qu de la Maladie qui a r£gne" dans I'Andalousie in 1800," printed at Paris 
in 1802) has stated at p. 67, as follows, via. : " On observait egalement a 
cette dpoque le hoquet, le vomissement noir : les malades rejetaient tantot 
du sang-, et tantdt de lVrabile ; et plus souvent ce9 deux matieres rar 
en me me temps fetides." 



45 

There is another mode by which the vomiting of black mat- 
ters i?i the Yellow Fever has been explained. Sir John IVc'gle, 
treating of this symptom, at page 197, of his Observations on 
the diseases of the Army, states his belief that the blood, 
* by oozing into the stomach, gives that blackish cast to what 
n thrown up:" and he attributes this oozing to the 
blood's being " here so much resolved." Dr. John Hunter 
entertained a similar opinion; "the blood." s;i\s he, " being 
frequently in a dissolved state, is forced into the stomach and 
thrown up, forming, what is (ailed by the Spaniards, the 
black vomit." See pap' (it of his Observations on the diet 
of the Army in Jamaica. Dr. Blane, however, apparently 
\s it'-, greater justice, thinks that "this happens, more probably, 
from a relaxation of tin on the surface of the alimentary 

emali than from a diss<>lved state of the blood." " The black 
matter." adds he, ** that is \omited. and the black colour of 
the feces and urine in the last and hopeless state of this dis- 
ease. Been to be owing to tin' propensity to Inemorrhage in 
the internal bu * page 4io-i. of his Observations 

on the Diseases of Seamen. It lias been ascertained by Sau- 
vages, and other physicians, that in Melu'iia, blood in various 
gradations of change, from a red fluid to a matter resembling 
the grounds of coffee, has been sometimes vomited by patients, 
wlttse stomachs weir found, on dissection, free from any 
abrasion or rupture of the Mood-vessels : and it is also known, 
that a vomiting of similar dark-coloured matters has occasion- 
ally happened suddenly to women in labour, especially in cases 
of rupture of the uterus, without being precedeo^by a \omitingof 
any other matters, and in patients, the coats of who* stomachs 
were obsersed to be perfectly sound upon examination alter 
death. A relaxation of the vessels on the surface of the 
Stomach, (which may be, and perhaps often is, accompanied 
some degree of inflammation) appears to be the cause to 
which the effusion of blood in such instances ought to be re- 



16 

ierred : and it such relaxation may take place in the affections 
just mentioned, it is to be presumed, that it may also take 
place in a disease of so debilitating a nature as the Yellow 
Fever, which is sometimes seen to occasion h?emorrha.ic<' s fro* 
many other internal surfaces. On these grounds, therefore, it 
seems not improbable, that a relaxation of the vessels of the 
stomach had existed in most, or all of tie 
in which the black vomit o ccur red with little or no pr« 
vomiting, or in which the coats of the stomach were enti; 
must, however, remark, that in the 

patients dead of the Yellow Fever, which have « 50HM I 
knowledge. I have found the cases just «!<■>. ribed, to boar only 
a very small proportion to the number of those in which i, 
had been done to that risctis; and I am. therefore, inclined to 
believe, that the black vomit is much less beqntutlj the conse- 
qoence of a relaxation of \rssels. than tf | separation of some 
portions of the internal I oats of the stomach. 

F must not omit to mention amoii£ tlie tpp - on iti^- 

section, that the lungs and pleura have sometime* been found 
to nave undergone some degree of infli *i daring the 

course of the Yellow Fever; but, although the sufii 
the patient must ha\e been gTOatlj in 
affection, it does not appear that the inflammation 
considerable as to warrant the supposition that it had canoed 
his death. 

AKKKI llo\s OK THE SKIN. 

The connexion between tbiianfclli and the alimentary canal is 
well known, and, ]>erha|>s, ivsults. in a considerable decree, 
from the identity of their membranes. This connexion 
contribute to some of toe appear b s srf ed on the surface 

of the body in Yellow Fever, which generally b ^ins aita more 
modei ate sensations of cold than otiier IWuTsj but soon pro- 



47 

duces strong arterial action, during which the skin become* 
excessively dry and jmrched, with an intensely burning or 
pungent heat. Sweats are in this stage a very rare occur- 
rence, and when they do appear, no relief is afforded hy them. 
A leeling of general soreness of the skin also takes place in 
Ulan} patients. But the most remarkahle symptom affecting 
the skin in this Fever, is a yellow suffusion; which, though 
far from being a constant symptom, occurs often enough to 
have given occasion for the name hy which the disorder is now 
commonly distinguished. The yellowness begins in a few 
CMC** within the fust forty-eight hours; sometimes on the 
third day, and frequently not until the fourth or fifth. It is. 
indeed, sometimes ohscr\ed hut a few minutes before, or a 
little after death. 1 believe thai in man} instances it might. 
With attention, be first diseoxeivd mi the ncs; hut it is com- 
monly first ohseiwed on the cheeks, extending towards the 
temples, and about the angles of the nose and mouth ; ahout 
the lower jaw and on the neck, along the course of the jugu- 
lar veins, whence it afterwards spreads in stripes and patches 
along the hreast and back downwards, so ;is at last to become 
universal in some patients, though in others it remains partial. 

The yellowness is sometimes of adingj or brownish hue. some- 
times of a pale lemon, and at others of a full orange colour. 
>\ hen the yellowness appears only in patches or spots, and of 
a ding} or brownish hue, these are frequently intermixed with 
other spots of a llorid red, or a purple, or livid colour. 

A considerable difference of oj>inion has subsisted respecting 
the cause of this s\ inploai : some ph\ sirians having ascribed 
it to serum, which has been rendered \ellow either by a colli- 
quation, or dissolution of the red globules, or by a peculiar 
action of the vessels, and afterwards effused under the cuticle : 
and some to an error loci of the globular part of the blood, 
which, as they conceive, might occasion yellow ncss, by getting 
into the smaller order of vessels, in consequence of their great 



48 

debility and relaxation, or into the cellular membrane : a* 
happens after Ecchymosis, from external contusion ; in which 
the skin, though at first livid, becomes yellow, when a part of 
the red globules is removed by absorption or otherwise. The 
late Dr. George Fordyce, in his fourth dissertation on F< 
(page 74) attributes the yellowness in question to tin* sehai 
matter, which he supposes to he then secreted more COVtOUslj 
In 1 sc sebaceous glands of the skin: he contends that. •• the 
colour is ?wy different from that which takes place in Jaun- 
dice," supposing, erroneously, that " the secretion roin the 
kidneys has not that deep yellowish brown, nor that thick 
sediment, which have almost always beea seen in those per- 
sons, in whom bile has got into the blood.* 1 Another author 
again, the late Dr. John Hunter, [w liorit} on this sub- 

ject is entitled to greater weight, from his experience in the 
Yellow Fever, and who had found, asr\er\ other person must 
have done, who has rcalh made the trial, that in this disease, 
"the urine is of a raj deep colour, and stains lines 
\ellow, like that of a person in the Jaundice." >. 
his Observations on the diseases of the Ann\ in Jan 
lieved it " probable that the inflammation in the coats of the 
duodenum and stomach, and the violent contractions they suffer 
from repeated vomiting and straining, may produce a spasm 
of the gall ducts, sullicient to interrupt the course ol the hile:" 
(See page 157 of the same work the consequence of which 
was. as he states at pages I3fl and IS7, that the bid 
•• absorbed and carried by the lymphatic teasels into tin 
beral mass of circulating fluids," and thus became •• the case* 
of the yellowness." And lastly, Dr. \> illiam Saunders thinks 
that, in the moiv aggnnated species of the Yellow rV\n . 
symptom u depends rather upon a particular state of the \\ mph 
in the cellular substance of the parts, than BOOS the absorption 
of bile into the circulating mass : " - n alu- 

able treatise on the structure, uecononn, and diseases of the 



49 

liver, 3d edition); but that in "the ordinary,*' i.e. " the 
Endemic Fever of the West Indies," " the Jaundice seems to 
depend upon a redundant secretion," the quantity of bile being, 
perhaps, so very considerable in this disorder, as he states 
farther at page <233, " that though the greatest part of it 
escapes into the primse vise, the whole may not readily find a 
i and the surcharge thus occasioned, may give rise to 

regurgitation and absorption." 

I was once inclined to adopt one of the latter Opinions, be- 
lecmed difficult to conceive by what other means, or 
from what other cause bile should be introduced into the blood 
Is in this Fever so as bp render the skiu yellow. That 
fluid is naturally intended to perforin all its offices in the ali- 
mentary (anal, and to be nil conveyed thither: and it is only 
when its passage through the ductus communis choledochus 
into the duodenum is obstructed, that nature is believed to have 
provided means for its escape into the blood vessels, in order 

to obviate the mischief which might result from an excessive 
accumulation of bile in the gall-bladder, and biliary ducts. 
But no such obstruction appears to exist in the Yellow Fever; 
the alvine faeces being commonly dark -coloured, s<» as to de- 
monstrate the admixture of bile; and the quantities of that 
fluid which are discharged from the stomach during the whole 
course of the disease, being such as to obviate all suspicion of 
an obstruction in the duct, and all probability of an accumula- 
tion of bile in the liver, or gall-bladder. These, however, and 
other objections against the existence of bile in the blood, as a 
Cause of the vellovv ness in question, were overcome in my mind 
by further consideration and inquiries ; and 1 am now disposed 
lo think that, with perhaps one partial exception to be here- 
after mentioned, the yellowness of the skin, which is frequent 
in this Fever, is derived from the bile. 

In the action of vomiting, the abdominal muscles contract 
Strongly, while the diaphragm is forcibly drawn downwards: 
by these motions the liver, from its situation immediately he- 
neath the diapliragm, and its large bulk and inelasticity, suf- 

7 



50 

fers a certain degree of compression. When this comprr- 
is moderate and gradual, as it appears to be in most cases of 
ordinary vomiting, it is probable that some portion of the bile 
contained in the biliary ducts is thereby propelled into the du- 
odenum, whence it passes into the stomach, and is thence 
throw up with other matters. When, however, there has been 
very frequent and violent vomiting for some length of time, 
the stomach, diaphragm, and abdominal muscles, are apt to 
become irritable to an extreme degi ach effort 

of the former to discharge its contents, the lattei 
er. as Mr, John Hunter lias observed, at page -158 of his work 
on the Animal (Economy, is u : often capable of forcing the 
bowels themselves out of the abdomen, producing ruptn; 
will frequently be thrown instantaneously into strong 
die contractions, and the liver together with the gall-bladder, 
will he, as it were, suddenly caught and tightly squeezed in a 
powerful press, the necessary consequence of which pre? 
seems to be, that all the fluids contained in that viscufl will be 
driven towards both extremeties. backwards as well IS 
wards, in those vessels which are not provided with valv< 
prevent their retrograde motion. l T nder such circun 
can scarcely be doubted, (after the experiments of* Haifa*, 
firmed by ethers, demonstrating the facility with which fluids 
may pass from the biliary dticts through the pari biliarii tats 
the hepatic \eins) that the bile will be forced to regurgitate in 
this manner, and pass from those duds into the vena cava, at 

* " Altera certissima anastomosis est ex ductibus biliariis in venam cavam, 
quam cl- ante me vin viderunt, & mea experiment* contirmant. Elem. 
Phisielog. Corporis humani. Tom 6. p. 509. 4to. 

«* Baron Hailer observes, that a subtile injection thrown in by the hepatic 
duct will escape readily by the hepatic veins. This is a fact ; and I know 
from experiment, that water injected in the same direction, will return by 
the veins in a full stream, though very little force is used. From the facility 
with which water takes this retrograde course, a probability arises tkat, if 
from any cause the natural direct.on of the bile be obstructed, it will readily 
obey the same (retrograde) direction." Dr. Wra- Saunders, Treatise on the 
Structure, &c. of the Liver, page 108. 



51 

each violent compression of the liver ; and that by continued 
and strong spasmodic contractions of the before-mentioned 
muscles in vomiting, a considerable quantity of bile may be 
carried into the circulation, and a yellow suffusion,* exactly 
resembling Jaundice, be, even very speedily, produced. It is 
in this manner that we must account for the universal yellow- 
<>f the skin which even in the time of Galen, has been ob- 
served to follow the bite of the viper, f when the poison was of 

♦ As the liability of the liver to such compression depenls on circum- 
stances varying in different individuals, and principally on its situation, 
form, and sire, and also on the suddenness and force by which the surround- 
ing muscles happen to contract upon it, we can hence understand why 
Jaundice may be more readily produced in one person than in another, al- 
though the symptoms might seem to be equally violent in both. We may 
likewise hence understand why infants, in whom the liver is, proportionably, 
much larger than in adults, and who are subject to numerous indispositions 
inducing strong convulsive contractions of the diaphragm and abdominal 
muscles, should be so frequently affected by Jaundice ; the cause of which 
affection, however, appears to have been overlooked, and mistaken by Haller, 
(Elementa Phisiologix corporis humani Tom. 6. page 590) for curdy mat- 
ters obstructing the common duct, and by others for viscid bile imparted 
therein, or other gratuitous suppositions. The only authors within my 
knowledge who have expressed a belief, that the bile might be driven into 
the blood vessels by the violent action of the diaphragm and abdominal mus- 
cles, and thus occasion Jaundice, are, Haller (in his work entitled, " Her- 
manni Boerhaave Pralectiones academic*," § 348,) and Van Swieten (in his 
" Commentaria in H. Boerhaave Aphorismos Sect. 631 and 950) ; these very 
learned Physicians, however, do not appear to have thought, that the violent 
action of those muscles simply could produce a Jaundice, for they suppose 
the pre-existence of gall-stones, or of some other obstruction in the cystic 
or common duct, by which the excessive vomiting that precedes the Jaun- 
dice in such cases, is always produced as a salutary effort of nature : but 
this supposition does not accord with the well-ascertained facts, that galU 
stones may obstruct the common duct, and produce Jaundice, without ex- 
citing any vomiting, even when they are attended with excruciating pain, 
and that Jaundice frequently occurs, although a free passage of the bile into 
the duodenum exists. 

f Fontana was led to suppose, that the yellowness of the skin in persons 
bitten by vipers is derived from the bile, which is carried into the circulation 
in consequence of the common duct being closed by some crisping or irrita- 
tion in the duodenum, arising from convulsive vomitings j but he offered no 



52 

sufficient force to produce the usual symptom of convulsive 
vomiting, and for the similar effects that have likewise been 
observed to ensue from the bites of some other venomous ani- 
mals. In these cases a deep yellow colour of the skin has been 
observed within even a single hour after the accident, (as 
Dr. Mead affirms, at page 9 of his mechanical account of poi- 
sons, 3d edition) and consequently too soon to have been the 
result of any thing but a regurgitation of bile as before explain- 
ed : for in regard to absorption, it is scarcely credible that the 
lymphatick vessels of the liver could ever, under any circum- 
stances, take up and convey into the circulation such a quanti- 
ty of bile as would suffice to produce Jaundice in that short pe- 
riod of time : neither is it readily to be perceived why, or how, 
in persons bitten by vipers, or in those labouring under certain 
affections to be presently mentioned, in w horn a yellowness of 

opinion concerning the means by which the bile is conveyed thither. " Con- 
venons done," says he, at page 68, vol- 1, of his work sur les poisons, " que 
si les sujets attaques par le venin devienncnt jaunes, il faut que la cause 
qui produit cet effet ait intercept le cours de la bile, apres qu'elle est se- 
paree dans le foie, sans avoir auparavant nui en rien a cette secretion Je 
croirois volontiers qu'elle ne se repand ainsi dans la masse des humeurs, que 
parc».que son cours est intercepts dans le canal choledoque avant qu'elle se 
d^gorge dans le duodenum Les convulsions de l'estomac et des intestins, 
qu'eprouvent ceux qui out €16 mordus par la vipere, peuvent tres bien irri- 
ter, et ensper le duodenum, et boucher ainsi cet orifice. Ne nous Stonnons 
pas non plus de voir la me me jaunisse se mamfester chez ceux qui ont pris 
d'autres poisons, puisqu'ils eprouvent aussi de semblables convulsions, un 
tiraillc-ment douleureux dans le creux de Pestumac, des vomissemens bilieux et 
convulsifs, une contraction autour de l'ombihc et d'autrts accidens dans le bas 
ventre." Fontana probably borrowed his gratuitous nation of a critping of 
the duodenum from Ylorgagni, (de Sedibus and Causis morborum. Epist 37. 
n. 35.) ; and Dr John Hunter appears to have taken his idea of" a spa^ir of 
the gall-ducts." as mentioned at page 36, from Fontana, combining With it, 
that of the bile being absorbed by the lymphatic vessels of the liver, and 
employing both to explain the occurrence of Jaundice ia the Yellow Fever. 
The bite of the rattle-snake does not cause excessive and convulsive vomit- 
ing, as that of the viper ; and it seems reasonable to suppose that the poisons 
of different snakes may be endowed, each with peculiar properties, and pro- 
duce different effects. 



53 

the skin is speedily induced, a particular system of vessels in a 
particular viscus, i. e. the lymphatics in the liver, should have 
their functions at once changed, and should on a sudden be ex- 
cited to absord bile copiously, and this while there is a ready 
exit for the passage of that fluid into the intestine, as is mani- 
fested by the matters discharged in such cases from the stom- 
ach and rectum.* In the same way yellowness of the skin, to 

* It may yet be doubted whether Jaundice be produced by absorption of 
the bile ir. any instance, even in a complete obstruction of the common duct 
by a gall-stone, although this is the mode in which it is now by most per- 
sons supposed to be always produced in that case- A justly eminent physi- 
cian relates an experiment made by himself, which, as he thinks, " evinces 
that the absorbents take up the bile from the interior part of the liver, and 
convey it by the thoracic duct into the mass of blood." He tied the hepatic 
duct in a living dog, and two hours after, the animal being strangled, he 
examined the parts. u On inspection," says he, " it appeared that the ab- 
sorbents had been very active, for they were very much distended with a 
fluid of a bilious colour, and their course, which was very conspicuous could 
be traced with the greatest ease to the thoracic duct, the contents of which 
seemed only moderately bilious. The bilious color r was in a great mea- 
sure, concealed by the red particles of blood, which had been extravasated 
by the injury, taken up by the absorbents, and conveyed into that canal It 
is probable, however, that the bile was only just entering the blood vessels, 
as on a very careful inspection of the eye, the tunica conjunctiva did not 
betray the slightest appearance of Jaundice " From this experiment the 
author dcaws the following conclusion. •* It seems then, that, during the 
space of two hours, the secretion of the liver had been sufficient in quantity 
to distend its ducts, — to stimulate the absorbents to relieve that distension, 
and to allow of a small portion of their contents to be conveyed into the 
blood vessels " 

This conclusion, however, notwithstanding my great deference for the 
opinions of this author, does not appear to me sufficiently supported by the 
preceding facts. It is, indeed, mentioned that the contents of the thoracic 
duct were " bilious ;" but they are admitted to have been " only moderately" 
so ; it is moreover acknowledged, that " the bilious colour was, in a great 
measure, concealed by the red particles of blood ;" and as it was by the eye 
alone, that the result of this experiment was determined, I think that a 
slight yellow tinge, which confessedly was almost " concealed by red," is 
not of itself of sufficient evidence to decide a doubtful point of great physio* 
logical, as well as pathological, importance. The presence of bile in the 



54 

a remarkable degree, attended with yellow sweats (which, as 
well as the urine, gave to linen a yellow tinge, have been 
sometimes produced by the excessive vomitings, and violent 
spasms, which ensue from eating some species of mushrooms in 
Europe, and certain poisonous fishes* in the East and West 

thoracic duct, would probably have been determined with greater certainty 
by tasting the matters contained therein. 

When the circumstances attending an obstruction of the common duct, 
by a gall-stone or other cause, are fairly considered, it seems highly probable 
that some regurgitation of the bile must happen, which, if continued for a 
sufficient length of time, may produce Jaundice : for,- in such a case of ob- 
struction, the bile will still be secreted as copiously as before, and must accu- 
mulate in the ducts, and distend the liver considerably beyond its usual size ; 
and it does not seem possible, that in this state the latter can avoid suffering 
almost perpetually some degree of compression by the mere actions of the 
muscles in respiration ; nor probable that, when thus turgid, it could be 
compressed without some portion of the redundant bile bring each time 
driven into the hepatic veins. Besides these, other stronger actions of the 
thoracic and abdominal muscles are likely to be very frequently excited by 
the general uneasiness, or local pains, accompany.ng this morbid condition 
of the liver, as in sighing, coughing, &c which may also force bile into the 
hepatic veins In these ways regurgitation appears to be of itself ade- 
quate to the production of Jaundice ; and if it be so, lo recur to the doc- 
trine of absorption, as another source of that disease, without any decisive 
proof that the bile is really absorbed, would only multiply causes without 
necessity. 

♦ Several authors of undoubted credit, as Kxmpfer, Frezier, Sloane, 
Catesby, Ulloa, Osbeck, Forster, &c have given accounts of various species 
of fishes found in the seas of warm climates, which frequently act as poisons 
upon those who have eaten them. The morbid effects produced by such 
food have been described by Dr Robert Thomas, now of Salisbury, but who 
formerly resided nine years in the West Indies, (at page 586 of his " Modern 
Practice of Physic, 3d edition) ; and among these, besides " severe vomiting 
and purging," he stage s the following ■ In the advanced state of the dis- 
ease, I observed that the whole surface of the body acquired a deep yellow 
hue as in Jaundice, and that the urine was likewise tinged of the same 
colour Even the perspiration gave a deep yellow tinge to the linen These 
appearances took place, in a very high degree, in one or two cases, but 
more particularly in my own, as I was so unfortunate as once to experience 
the deleterious effects of a poisonous rock fish," (perca marina) 

As the fishes in question are poisonous at some times and situations and 



55 

Indies, and also from swallowing a violent dose of arsenic, or 
other poisonous substances. And if the vomitings and spasms, 
arising from these causes, are found in a multitude of instan- 
ces, to produce general yellowness of skin, with such excre- 
tions, by urine and sweat, as manifest the presence of bile, we 
may surely infer that the severe vomitings, which occur in the 
Yellow Fever, may produce the like effects, and that they also 
may cause the introduction of bile into the blood-vessels, and 
thus induce the yellow suffusion of the skin under our consid- 
eration. In like manner, temporary jaundice is sometimes 
found to arise from Spasmodic colic,* Hysterics, and, as Hal- 
ler,f Lind, and other highly respectable physicians have de- 
clared, strong passions of the mind. 

The exception to the yellow suftusion being generally deriv- 
ed from the bile, to which I lately alluded, refers to those rases 
in which the yellowness of skin occurs partially, i. e. in patch- 
es or spots, previously to, or shortly alter, death, Or in which 
the patches are of an obscure or dingy hue, and intermixed 

not at others, it is not improbable that their poison is acquired by feeding 
on certain noxious submarine plants or other substances. They are said to 
be rendered innocent by being laid for some hours in salt- 

* Dr William Saunders, whose opinions concerning the origin of the 
yellowness of the skin in the two supposed species of Yellow Fever have 
been lately stated, attributes the Jaundice, that sometimes follows the 
affections here mentioned, to the same cause which Fontana believed to pro- 
duce the yellow suffusion in persons bitten by vipers. " When Jaundice 
has arisen from very acrid emetics or griping purgatives, or colic, or 
hysteria, the resistance to the free passage of the bile, is either at the very 
extremity of the ductus commuuis, or during its oblique course through the 
substance of the duodenum, at which part it is liable to compression from 
the muscular action of that intestine."— See page 243, of his Treatise on 
the Liver. 

• Naseitur enira icterus, et bilis adeo retrograda in sanguinem refluit plu- 
rimas ob causas, quarum aliqux vix corporeae sunt, ut ex ira." " Hue 
maeror profundior, terror," 8cc— Haller Elem- Physiol. Corp. Human- Tom 
vi. p. S92. 

"A violent fit of anger or grief will immediately produce a Jaundice." — 
Lind- page 177, on his Essay on the Diseases of Europeans in Hot Climates- 



56 

with petechia ; the yellowness may, peril aps, in these instan- 
ces, be produced by a cause similar to that which produces 
the yellowness that follows Ecchymosis ; and this cause is 
probably connected with that particular state of the blood, and 
of the vessels, which occurs in the worst cases of the disorder, 
and gives rise to Haemorrhages from various parts of the body, 
external and internal. It seems admitted by all practitioners, 
that these yellow patches on the skin indicate extreme danger ; 
but a general yellow suffusion, such as I suppose to arise from 
bile, which is forced into the blood vessel by the temporary 
compression of the liver, is, according to my own experience, 
and that of many practitioners w ith whom I have conversed, a 
symptom of little real importance in the Yellow Fever ; the bile 
so introduced being in all probability, incapable of doing any 
more considerable mischief than it is observed to do in those 
cases of Jaundice, which have succeeded to a* colic, or a 
strong hysteric fit, &c. It has, indeed, been associated with 
extreme danger in the Yellow Fever, by most writers on that 
disease, but only, as I believe, because the excessive vomiting, 
which had produced it, had also produced other more destruc- 
tive effects. 

DIAGNOSIS. 

Having thus stated, and endeavoured to account for, the prin- 
cipal symptoms of the Yellow Fever, I shall conclude this part 

* When a Jaundice is produced by the affections here mentioned, it will 
gradually disappear without any aid from medicine ; if the suffusion be 
slight, it will vanish in a few days ; but it* iteep, and approaching to an or- 
ange colour, it will generally require from four to six weeks for its removal. 
The kidneys seem to be the principal means by which the bile, and most 
other unnecessary ingredients, are extracted from the circulating mass, a 
portion of bile, corresponding with the quantity thereof existing in the 
blood-vessels, being voided in every discharge of urine. An infinite number 
of remedies are recorded, by which the Jaundice is stated, and was believed, 
to have been cured ; and the above explanation may serve to point out the 
real degree of their respective virtues, as well as their modes of operatiou 
in such cases. 



51 

of my subject with noticing some of the diagnostics, by which 
it may be distinguished from the distemper properly called the 
Plague, and from that fever which is now known, in this coun- 
try, by the name of Typhus, — two diseases with which it has, 
by some writers, been, even lately, assimilated and confounded. 
The Yellow Fever prevails only in those countries, and in 
those seasons, in which the heat is, or has recently been so 
great as would destroy, or stop the progress of, the Plague ; 
and it is for this reason that the latter disease has never been 
known to exist in intertropical countries, the temperature of 
which, however, is eminently suited to the existence of the 
Yellow Fever. The latter disease is not accompanied with the 
glandular and cutaneous affections, called Buboes and Carbun- 
cles ; some of which, especially the former, always accompany 
the Plague ; for although, patients are sometimes cut off by the 
latter disease, before Buboes appear above the surface of the 
adjoining parts, their germs may nevertheless, as I believe, be 
always felt, after death, in the glands near the groin or axilla. 
It is true, indeed, that the parotid glands are occasionally af- 
fected in Yellow Fever ; but this is not a common affection* 
and it differs greatly from the glandular tumours which occur 
In the Plague. The Yellow Fever is moreover, always atten- 
ded by a violent febrile paroxysm : — this is essential to its 
character ; but it is admitted by several writers on the Plague 
and I have myself witnessed the fact, that persons have been 
attacked by the latter disease without having the least febrile 
affection, — an occurrence which has also been observed in the 
Small-Pox, in the Scarlet-Fever, and in the Measles. Final- 
ly, Blacks are very rarely seized with the yellow Fever, 
and when seized, they are much less violently affected by it 
than Whites living under the same circumstances ; but I had 
occasion to observe, in Egypt, that Blacks were not at all less 
susceptible of the Plague than Whites, and that they died of it 
in a far greater proportion. 

Yellow Fever differs from Typhus in the following circum- 
stances, viz. it prevails, as I have already mentioned, only 

8 



58 

during, or immediately after, very hot seasons, in which Ty- 
phus is soon extinguished ; and it is, in its turn, completely 
extinguished upon the accession of cold weather, in which Ty~ 
phus is commonly most prevalent ; it attacks most readily and 
most violently the young and rohust, over whom Typhus is 
allowed to have the least power ; — it begins with much greater 
exertions of the living power than Typhus, — is attended with 
many different symptoms, and terminates much sooner ; — it is, 
besides, disposed to remit, and it frequently changes into a 
regular remittent, and sometimes even into an intermittent 
fever, which true Typhus is never observed to do. There are 
some other very important circumstances in which the three- 
diseases differ from each other, but these are reserved for 
another place. 

PROGNOSIS. 

Having already stated all that I had to submit in regard to 
the prognosis in the Yellow Fever, I must beg permission to 
refer the reader, who desires farther information upon thai 
subject, to the treatises of former authors. 

TREATMENT. 

In offering some observations concerning the cure of the Yel- 
low Fever, it is not my intention to recommend any particular 
indiscriminating mode of treating the disease, in its several 
forms and varieties, being persuaded that none which I could 
devise would be found adequate to all cases of the disorder : 
but my sole aim will be to point out the general principles by 
which, as I conceive, the most urgent symptoms may be re- 
relieved, and the violence and fatality of the fever lessened. 

BLEEDING. 

The remedy which first presents itself to our notice is 
bleeding, as being proper only in an early stage of the disease. 



59 

Concerning this evacuation, the most opposite opinions have 
been delivered, some considering it as an indispensable remedy, 
and others alleging that nearly all who were bled had died. 
The number of persons who have survived, after copious 
bleeding, in this disease, among whom I may be included, are 
a sufficient proof that this evacuation is not necessarily fatal ; 
and, therefore, we can only account for this contrariety of 
opinion, by supposing that, where bleeding has proved hurt- 
ful, some important mistake must have been made as to the 
necessity of that evacuation, or as to the quantity of blood re- 
quired to be drawn. 

It has already been observed, that the Yellow Fever, espe- 
cially the violent forms of it, seldom occur among any other 
persons than strangers recently arrived from temperate cli- 
mates, the greater part of whom will commonly be found to 
be young, robust, and vigorous. — Hence we might be led, a 
priori, to believe, that these persons would be most liable to 
that inflammatory disposition, which is well known to be a 
very frequent concomitant of the intermittent and remittent 
fevers common in Europe ; but we can have no hesitation in 
regarding the Yellow Fever as a disorder frequently, in its 
first stage, accompanied with a very considerable degree of 
general inflammation, (a degree which is, perhaps, greater 
than occurs in any other kind of fever) if we attend to the 
leading symptoms which are visible at the commencement of 
the disease, — I mean the hard, full, and strong pulse, — the 
distressing sense of universal distension, the red, starting, 
watery eye, and the parched skin. Dissections, moreover, of 
persons, who were victims of this disease, have very generally 
exhibited signs of considerable inflammation in various organs, 
and especially in the head and stomach. Now experience has 
clearly demonstrated that general inflammation always in- 
creases the duration of the paroxysm, whenever it supervenes 
in a fever of an intermittent or a remittent type, (as the Yel- 
low Fever is) without being removed, and that it likewise 
-augments the severity of all the febrile symptoms 5 the conse* 



60 

quence of which is either that the patient is often destroyed 
during the paroxysm, though he might otherwise have sur- 
vived; or, at least, that extreme weakness, with all those 
symptoms called putrid,* which are its usual effects, is more 
speedily induced. To avoid, therefore, the mischiefs arising 
from such superadded violence, no means appear to me so 
certain or beneficial as bleeding ; but, that it may prove ad- 
vantageous, it ought to be performed copiously ; and from a 
large orifice, as early as possible after general inflammatory 
action is perceived ; it being sufficiently ascertained that such 
action is more speedily and completely subdued by taking 
away a large quantity of blood at once, in this manner, than 
by a larger evacuation at two or more bleedings ; and that, 
although the patient may be much debilitated at first by the 
former, his strength will, in the end, be less exhausted than 
by the latter. Those physicians, who have found the greatest 
benefit from this remedy in the Yellow Fever, insist most 
strongly upon the necessity of bleeding early, (as within twen- 
ty-four hours, and even twelve if possible, from the attack) to 
the amount of twenty-four or thirty ounces in the more violent 
cases ; but in mentioning these quantities, it is not my inten- 
tion to recommend that all patients should indiscriminately be 
bled to such an extent : the necessity of this evacuation, and 
the quantity in which it is to be performed, can only be indi- 
cated by the vigour of the patient's constitution, and the pre- 
sence of inflammatory symptoms, and their degrees of violence 
and previous duration ; — and doubtless, in some patients, 
bleeding may be superfluous, or detrimental. 

* It is not uncommon, in hot climates, for the symptoms denoting putri- 
dity, to supervene within two or three days after the commencement of 
fever ; and this has led several systematic medical writers, the greater part 
of whom have never been out of this island, to believe, and assert, that the 
fevers of hot climates are usually putrid, and very seldom inflammatory. These 
writers, however, seem either not to have been aware of the violence, and 
exhausting nature of the symptoms, which precede the appearances of pu- 
tridity, or not to have been acquainted with the true causes of those ar 
pearances. 



61 



COLD WATER. 

One of the least tolerable among the earlier sufferings of 
the patient in this disorder, is a sensation of burning heat 
through the whole body, which is far from being imaginary, 
as his general temperature frequently rises four degrees, or 
more, of Farenheit's thermometer, above the natural standard. 
Happily we have a remedy for this most uneasy and formidable 
symptom, in the external use of cold water, — the safe and 
efficacious operation of which has been very ably explained by 
the late Dr. Currie. The modesty and generous delicacy of 
this estimable man, have led him to do injustice to himself, 
that he might perform what he thought an act of justice to the 
supposed discovery of a contemporary writer, from whose prac- 
tice, in a distant country, as reported to him, he had first de- 
rived the idea of employing cold bathing in fevers. In doing 
this, however, he could not have been fully acquainted with 
the claims which several physicians, ancient as well as mo- 
dern, had to acknowledgments of the same nature, for having 
recommended, or mentioned, the external application of cold r 
by bathing, or otherwise, in febrile disorders ; and especially 
Hippocrates,* who, in several parts of his works, has given 

* A multitude of instances might be cited from the works of this great 
physician, shewing the extensive use which he made of cold and of warmth, 
especially in external applications, towards the cure or relief of general or 
local affections ; but I shall content myself with referring to only a few such 
instances, observing that his practice appears to have been grounded upon the 
general principle of restoring the due temperature of parts, by cooling those 
which he conceived to be too much heated, and of comforting, by warmth, 
those which were either too cold or debilitated ; — a principle which, after 
some experience, I am inclined to consider as the best practical rule upon 
this subject that he could have followed. And Hippocrates had, in this re- 
spect, so judiciously adapted his practice to the suggestions of nature, as 
to have discovered that heating and cooling applications might be usefully- 
employed, at the same time, with the same patient, for the puroos of cor- 
recting the deficiencies and excesses, of heat in different parts. Some pas- 



particular directions for the employment of cold water, which 
are almost as judicious as Dr. Currie's. If, however, as Mal- 
pighi says concerning Harvey, " in arts and sciences he is 
properly to be deemed the discoverer, who, by a proper inves- 
tigation, unravels nature's perplexities, and calls in reason 

sages, it is true, may be found which seem to contradict the above-mentioned 
principle ; but these are comparatively few, and might justly, perhaps, be 
included among the interpolations with which the writings, commonly as- 
cribed to Hippocrates, are, on good grounds, believed to abound.— See the 
treatment directed in the disorder termed Distension of the Lungs from 
Inflammation, in the third book de Morbis, (page 489, line 29 to 53. of the 
edition of the Works of Hippocrates, by Fcesius's, printed at Geneva, in 1657;) 
in Ilei, also in the third book de Morbis, (page 491, line 34 to 46 ;) in Cau- 
sus, in the book de Affectionibus, (page 518, line 41 to 50;) in Tertians 
and Quartans, (page" 520, line 48 ;) in Typhus, in the book de Internis Affec- 
tionibus, (page 553, line 25 to 38;) in Ulcers, in the book de Liquniorum 
Usu, (page 426, line 45 to 47.) See also the Cases, in the fifth book of Epi- 
demies, of the woman in Larissa, ill of Puerperal Fever, cured by water very 
cold, (page 1144. F.) ana of another woman, who, being in appearance dead, 
was recovered by throwing thirty amphorae of cold water over her, (page 
1153. B. C.) Hippocrates had likewise successfully employed effusions of 
cold water in Tetanus and Opisthotonus, — (See the th'.rd book de Morbis, 
page 491, line 30 to 33, and the book de Liquidorum Usu, page 427, line 34, 
the latter of which two passages is repeated in the fifth book of his Apho- 
risms, 21.) and even in the Gout, as appears from the twenty-fifth Aphorism 
of the last- mentioned book, and from the book de Affectionibus, (page 524, 
line 23, 240 

It is net improbable that Hippocrates borrowed his modes of using cold 
water from similar uses, which he might have observed in the course of his 
travels through rude nations, among whom that natural and simple remedy 
for excess of heat was likely to be much employed, especially in Fevers. 
The two following passages will prove the existence of a like practice among 
very unenlightened people in other and opposite parts of the world. 

The first is taken from a manuscript letter, (preserved in the library of 
the British Museum, and marked in Ascough's catalogue, 4432. 71.) which 
was written by Dr. Oliver Coult, at Calcutta, to Dr. Mead, and is dated the 
25th of November, 1718. ♦« I am credibly told, (says Dr Coult) that, upon 
the coast of Sumatra, Pegu, and Siam, the natives, in fevers of all kinds, 
whether continued, intermitting, or eruptive, also in diarrhoeas and slow 
dysenteries, wash frequently in the rivers, which are very cool, in the season 
of rains," (from June to November.) 



63 

and experience to support, and facts to confirm, what he as- 
serts," then will Dr. Currie doubtless be esteemed the dis- 
coverer of this remedy. 

It is only when the heat of the body is above the healthy 
standard, that cold water should be applied externally 5 and 
the patient's feelings will sometimes best direct how long and 
how frequently the application should be made ; but we ought 
always to recollect that, if he should become chilled by it, not 
only mischief may be caused by driving a considerable quan- 
tity of hlood from the surface to the internal parts, especially 
the brain, but also a violent re-action of the system might be 
produced, which could scarcely fail of protracting and aggra* 
vating the paroxysm. 

As the usual modes of applying cold water to the surface of 
the body, viz. by placing the patient in a bathing-tub, filled 
with water, or pouring water over him, or washing him with 
wet sponges, while sitting on a stool, may sometimes cause 
serious disturbance and fatigue to him, and are often attended 
with difficulty or inconvenience enough to deter both patient 
and attendants from persisting in their use for a sufficient 

The second will be found in a well-written tract, composed by a Mr- Bour- 
geois, Secretary of the Board of Agriculture at the Cape in St Domingo, in 
1755, entitled " Memoire sur les maladies les plus communes a Saint Do- 
mi'ig-uc ; leurs remedes," &c. and contained in a volume of '* Voyages in- 
teressans dans differentes colonies Francaises, Espaenoles, Anglaises, &c. a 
Pans, chez Jean-Franjoise Bastien, 1788." «« L'habitude des Negres qui 
veulent gueVir des fievres est de se jtter dans l*eau la plus froide, de s'y 
baigner, & de se mettre sur la tete des herbes fraiches qu'ils arrachent au 
fond des ravines ou des rivieres. J'en ai vu l'essai sur des blancs, qui con- 
venient que cela leur otait l'ardeur de la fievre, que le mal de tete cessait 
presque aussi-tot, & qu'ils se sentaient soulageV Plusieurs m'ont meme 
dit en avoir e'te' gueYis. Ces herbes se changent d'instant en instant, and se 
retirent toujours aussi chaudes que. si on les t.ut fait bouillir: elles procu- 
ren vie fortes transpirations, & d£barassen+ surtout la tete. J'ai eprouve' ce 
xenede sur moi-meme. Mais pourquoi douterait-on de son efficacite" ? qu'on 
se r ppelle ce que rapporte Chardin, de la maniere dont la fievre se gue'rit 
en queiques lieux d« i'Onent tu l'on ne connuit d'autre cure, que de se 
j&re jeter sur le corps des seaux de Teau la plus fraiche,"— P. 488. 



64 

length of time, a safe and useful substitute may be procured, 
by covering the patient, as he lies in bed, with a single sheet 
wetted* with cold water, which, by evaporation, will gradually 
reduce the temperature of his body to a proper standard. 

The addition proposed by two or three writers of distilled 
spirit, — as rum, — to the water which is employed as a bath, 
would, indeed, contribute to cool the patient more speedily ; 
but it may be disagreeable, if not injurious, to the patient, to 
inhale the spirituous vapours ; and it is probable that the pro- 
cess of cooling by water only in the management just mention- 
ed will be sufficiently quick and effectual in most cases. 

Besides the external application of cold water, there is an- 
other use of it, I mean the drinking of it in small quantities 
frequently, which, as I have good reason to believe from per- 
sonal observation, will be found of great efficacy, in moderating 
the excessive heat of the body, as well as the violence of general 
febrile action; also in disposing the skin to perspire gently: 
and in preventing inflammation of the stomach, or diminishing 
and removing it after it lias been excited. The utility of fre- 
quent draughts of the coldest water in the cure of ardent fV\ 
and likewise in various other inflammatory disorders, was very 
generally known among the ancientf physicians, as is evident 

* The mode here proposed of carrying off the superabundant heat of the 
body in fever, may be us^d in this country during vrarm weather ; but, during 
cold weather, if the patient's room be not too much heated, he may, in ge- 
neral, be sufficiently cooled, by merely diminishing the quantity of his bed- 
covering. 

f It is true that these ancients differed among themselves about the proper 
time of administering cold drinks in fevers ; — Celcus, Galen, and most of the 
other Roman and Greek physicians, deeming it dangerous to administer them 
before the fourth day, or before those appearances, which they regarded as 
the signs of concoction, had taken place ; while the Arabian Physicians gave 
cold drinks in the beginning, without waiting for such signs ; the latter 
practice, however, has been proved by more modern experience, to be safe 
as well as advantageous ; we cannot, therefore, wonder that gome sanguine 
physicians should have pushed it to an extreme, and employed it alone in 
the treatment of febrile disorders, as in the di*ta aquea of certain Italian 
Physicians. 



65 

from the writings of most of those whose works have been 
handed down to us ; and it has been so fully established by the 
experience of many of the most considerable medical writers 
on the Continent during the last two or three centuries, espe- 
cially in Italy and Spain, that it is a matter of no less sur- 
prise than regret, that this beneficial remedy should have been 
so little employed by British* and American physicians in the 
cure of the Yellow Fever. It is scarcely necessary to add, 
that in places where ice or snow is preserved during the hot 
season, water-ices, made with acidulous fruits, will be found a 
safe and very pleasant mode of diminishing febrile heat. 

PURGATIVES. 

The state of the primae vise likewise demands early attention;. 
Costiveness frequently precedes, and generally accompanies* 
the Yellow Fever ; and as an accumulation of faecal matters 
usually produces morbid irritability in the whole intestinal 
canal, but more especially in the stomach, and aggravates 
other symptoms, it is highly expedient to employ a cathartic 
without delay. The medicine, which should be given for this 
end, ought, for reasons which I shall immediately explain, to 
be such as will not offend or irritate the stomach by its bulk or 
quality ; and unless there be considerable determination to the 
head, the dose ought not to be very powerful, lest the patient 
should be too much reduced by excessive evacuations, and a 

* Dr. John Williams, of Jamaica, and Dr. Rush, are two of the tew exceptions I 
have met with to this remark. — " Lai'ge draughts of cold water, (says Dr. Williams) 
or other cool liquors, have occasioned profuse sweats, when all tlie sudorificks in the 
shop would not have had the same effect." He adds, " I have often observed that 
those persons who had this (the Bilious or Yellow) Fever on board of the vessels in 
the harbour, who seldom drank any thing but coldtvater, no beds to lie on, or clothes 
to cover them, with a free admission of air, frequently recovered " — See pages 16 and 
27 of " Essays on the Bilious Fever, containing the different opinions of those eminent 
ph\>icians, John Williams, and Parker Bennet, of Jamaica." London, 1752. 

Dr. Currie has made some useful observations on cold drinks in the 11th chapter of. 
vol. i. of his Medical Reports on the Effects of Cold Water. 

9 



66 

prolongation of the paroxysm, or a diarrhoea be the conse- 
quence. Calomel, with Scammony, Jalap, Gamboge, and 
similar purgatives, will best answer the above purpose ; and 
it will be proper to repeat them as may be requisite, in order 
to procure two evacuations daily during the continuance of 
the fever. 

EMETICS. 

Emetics have been recommended in the begining of this dis- 
ease by some, but reprobated, and as I think, very justly, by 
other writers, in no respect inferior to the former, either in 
discernment or experience. My reasons for condemning the 
use of emetics are, — first, that they commonly fail in their 
principal object of removing nausea, which is very apt to con- 
tinue, and even in a greater degree than before ; for tliis 
symptom rarely proceeds from any load of undigested food,* 



* It is, perhaps, only for the purpose of removing such undigested food, and Uiercby 
preventing the injurious effects which its continuance in the stomach would occasion, 
that vomiting can be beneficially employed in the Yellow Fever ; and, in cases of this 
description, the above purpose may be sufficiently attained, if not by draughts of tepid 
water alone, to aid the stomach in discharging its offending contents, at least by a 
moderate dose of Ipecacuanha, which is a more certain emetic than any of the p 
tions of Antimony in use, and is also preferable to the latter for other reasons pn 
to be explained. 

The practice of giving emetics in the beginning of fevers, has probably been rendered 
more general by the opinion first advanced, as I believe, by Sir John P. - 
page 290, of his Observations on the Diseases of the Army) and afterwards adopted 
and maintained by Dr. James Lind, who, in his Dissertation on Fevers and Infection, 
chap. 2, says, that " if a person be seized with chills or sickness, after examining a 
prisoner, visiting a prison, or being in a crowded Court of Judicature, where pi v 
suspected of infection, have been tried, a vomit taken immediately seldom or never 
fails to prevent the future mischief;'' — (See page 346 and also 248 and 257, of his 
Essay on Preserving the Health of Seamen, second edition ;) but I am persuaded, by 
numerous facts which have fallen under my observation, to be stated in another part, 
that in all the instances adduced by Dr. Lind to suppoit his opinion, no one of the per- 
sons, whom he supposed to have been infected; and to have been preserved in this 
mode from fever, was reallv infected ; aud I am likewise persuaded by other f.u 
to be stated, that when a person has imbibed a dose of contagion sufficient to produce 
fever, a vomit will not only not prevent, but, on the contrary, assist its production. 



67 

or bile, or phlegm in the stomach, but seems rather to proceed 
from other causes, such as sympathy with the morbid state 
of the brain, or of the surface of the body, or else from an in- 
flammatory affection of the coats of the stomach itself; and 
these are causes which emetics have but little power to re- 
move. Secondly, the patient cannot vomit without making 
violent efforts, which will exhaust his strength, increase the 
circulation, and propel a large quantity of blood into the head 
where it may occasion the most serious mischief. Thirdly, 
there is a peculiar tendency in a warm temperature, to render 
the stomach and intestines relaxed, irritable, and liable to 
inflammation ; hence the great prevalence of Cholera Morbus 
and Dysentery, in all countries, towards the end of Summer 
and in Autumn ; and this natural effect of heat is, in no dis- 
ease, more perceptible than in the Yellow Fever, irf which a 
disposition to vomit is usually a very early symptom, and one 
of the most difficult to allay, as well as one of the most fatal 
if not allayed ; for what is properly understood by the term 
of the Black Vomit, rarely occurs except as the sequel to fre- 
quent vomitings, nor can we be surprised at the remarkable 
frequency of this disposition to vomit, since we learn, from 
very numerous dissections, that the stomach is more or less 
inflamed in most of those who have died of the Yellow Fe- 
ver. Instead, therefore, of prescribing emetics in this disor- 
der, it soon became my chief anxiety, while attending the sick 
in military hospitals, in the West Indies, to calm the irrita- 
tion of the stomach by every possible means ; and I had full 
employment in this occupation ; for the greater part of my 
patients, in the Yellow Fever, were persons to whom emetics 
had already been administered before they were sent into the 
hospitals. The mode which proved most successful towards 
effecting this intention, when patients, with constant vomiting* 
came under my care, was to give small doses of Opium, as 
half a grain, at intervals, at first of half an hour, and after- 
wards of one or two hours ; to procure sufficient alvine eva- 
cuations, where the bowels had been torpid, by clysters, and 



68' 

also by combining moderate doses of tbe more powerful purga- 
tives, as Calomel, Scammony, Jalap, &c. with the Opium, 
such evacuations being highly useful towards checking the 
vomiting, by promoting the natural propulsory action of the 
stomach and intestines ; to apply a large blister or sinapism 
over the epigastric region, and to forbid the patient from swal- 
lowing food of any kind, liquid or solid, as the presence of 
even a very small quantity in the stomach always renewed the 
strainings to vomit. The patient was, however, directed to 
rinse his mouth frequently with lemonade, or some other 
pleasant and acidulated liquid. 

When this treatment had been persisted in for eight, ten, 
or twelve hours, I generally found that the vomiting had sub- 
sided, and that the patient was able to retain a little food, 
which I then allowed him to take, at first in small portions, as 
11 tea spoonful or two, and gradually* in larger : and I have 
the satisfaction of knowing, that very many persons were en- 
abled to take sufficient nourishment, and in the quantity of half 
a pint or more at once, within a day or two after this simple 
plan of treatment had been adopted, and that they finally re- 
covered ; when it seemed highly probable that they would 
have been carried oft* in the same space of time, if, according 
to the mode which some authors have advised, and many prac- 
titioners have pursued, I had kept the stomach in a perpetual 
state of irritation, by forcing the patient, who had rejected 
one potion, immediately to swallow another, perhaps pos^ 
ing even a more stimulating quality than the former, f 



* I have very often found that patients, in the condition here described, were able to 
retain, and relished, small quantities of spruce beer, cooled as much as possible, when 
almost every thing else disgusted them, or was njected by the stomach. 

f Although Dr. Cullen and Dr. George Fordyce, two of our greatest modern teach- 
ers of medicine, have been partial to the use of emetics, and have recommended them 
in the commencement of Fevers, the weight of their recommendation, so far as it re 
t,ards the treatment of the Yellow Fever, is considerably lessened bv recollecting, that 
neither of them was personally acquainted w ith any but the Fevers of this country, 
which are much less violent in their symptoms, and less rapid or dangerous in their 
Course, than tire Fevers of hot chinales, and in which it is certain, 



69 

Though opium, as I have found, given in the manner above- 
mentioned, may be of great service towards putting a stop to 

given with greater safety than in the latter : yet the following passages from their 
works will show, that both these experienced physicians were aware of the had effects 
which emetics are cap«b;e of producing. 

Cullen. First lines of the Practice of Physic, paragraph CLXXVIH. " It is sel- 
dom that vomiting is found to produce a final solution of Fevers ; and, after they are. 
once formed, it is commonly necessary to repeat the vomiting several times ; but this 
te attended with inconvenience, and sometimes with disadvantage. — The exercise of 
vomiting Is often a debilitating power; and therefore, when the vomiting does not re- 
move the atony and spasm very entirely, it may give occasion to their recurring with 
greater force." 

Fordyce. Third Dissertation on Fever, second part, page 73. " It happens some- 
times, when an emetic is employed, that, with every precaution, the sickness will con- 
tinue, and the patient shall pass a restless and distressing night, more so than would 
probably happen if no emetic had been exhibited." 

Id. Fourth Dissertation on Fever, page 80. "Preparations of antimony, ipeca- 
cuanha, and other medicines, which produce symptoms similar to those which take 
place in the ordinary crisis of Fever, and especially Dr. James's powder, have frequent- 
ly been employed in this very violent disease (the Yellow Fever). The patient's 
stomach very soon becomes so extremely irritable, that any dose of such medicines 
which might be expected to be at all efficacious, has produced vomiting ; which, when 
it takes place in any great degree, has hardly ever been got over, but has destroyed 
the patient. 7 ' 

Sir John Pringle was also aware of the disadvantages of emetics in the advanced state 
of Fever. See page 308 of his Observations on the diseases of the Army. 

Some useful instruction concerning the injuries that may be caused by emetics, and 
particularly by antimonial ones, in the treatment of Fevers, is to be derived from the 
account given by M. Le Cat, M. D. (and published in the 49th vol. of the Philosophical 
Transactions, part 1, page 49) of a " malignant Fever that raged at Rouen, in the 
winter of 1753-4," where " the havock it made gave them the reputation throughout 
Europe of having the plague." This was the contagious Fever to which Dr. Cullen 
has applied the name of Typhus; a disorder, in a great measure, peculiar to the 
British Isles, and but little known to French physicians ; for which reason it appears to 
have been very unsuccessfully treated by them whenever it has been introduced into 
Brest, or other ports or towns in France by English prisoners of war. The treatment 
pursued by M. Le Cat on the above occasion was, " after a bleeding or two," a vomit, 
the foi'mula of which was " four grains of emetic tartar dissolved in a quart of water, 
the fourth part of which is given at a time ; after this had worked either by vomit or 
stool, another fourth was taken, and so on, till the patient was supposed to have vomited 
or purged enough." This remedy sometimes produced " a small flux of five or six 
Stools a day." and i,s thereby said to have effected a cure, as it might do in slight cases ; 
" but wh • this success dirt not follow , the patient v as aga n bled, first in the arm, then 
m the foot, and every two ©r three days there was given some cassia, quickened by aft 



70 

excessive vomiting, much caution is nevertheless required in 
the use of it ; for if it be given freely, and in a larger quantity 
than is necessary for quieting the stomach, delirium and coma 
may be brought on, affections not less to be dreaded than that 
which the opium was intended to remove. And, indeed, it 
will be found of the greatest consequence, throughout the dis- 
ease, to pay unremitting attention to the state of the brain, and 
to moderate, as far as possible, every action which threatens 
mischief to that most important organ. 

If, therefore, the patient should, after having been suffici- 
ently bled, complain of very severe pain in the head, or 
be delirious, or comatose, it would be proper to support him 
in bed, so that his head may be raised, to apply a blister at 
the nape of the neck, or between his shoulders, and to keep 
cloths wetted with cold water wrapped round his head : 
and if these should not have procured the desired relief, to 
have the head shaved, and fix a large blister over it, by which 



emetic, in a decoction of tamarinds." From vomitings and purgings thus reiterated, 
the reader will not be surprised at the following appearances having been discovered 
In the stomach and intestines on examining the bodies of " many" of those who died, 
viz " In some, part of the villous coat of the stomach, and of the small guts was in- 
flamed, and the rest of these organs were filled with an eruption of the miliary crystal- 
line kind, except that it was larger." " In others, a strong inflammation had seized 
the whole stomach, and a small portion of the oesophagus, but the intestines were free." 

In those cases where the delirium had continued long and violent, we found either 
ulceratiou on the stomach, or its villous coat separated, together with a great inflamma- 
tion, pnd even some gangrenous spots on the other coats of that organ.*' 

"The manner of recovery from this disease, adds M. le Cat, deserves a place in the 
history of it. There were but few who recovered of it in the usual wnv, that is to say, 
who only wanted the restoration of their strength, exhausted as well by sickness as by 
the medicines. Almost all of them, even those who had it in the first and second de- 
gree, (the mildest degrees) still felt some remains of the symptoms of the disease ;" 
" others who escaped the mortality of this dangerous poison, earned about w ith Uieru 
for several months and still feel, its terrible effects." 

M. Le Cat appears to have had no suspicion that the above appearances, and slow 
or imperfect recoveries, were the consequences of his mode of treatment ; for, in men- 
tioning that treatment, he styles it "the most successful," which it might have been, 
compared with other modes then in use; but to have (erroneously) considered them 
: as characteristics of an unusual and peculiar distemper. 



71 

ileep is frequently soon induced, and severe pafn in the head 
greatly mitigated or removed, after other usual means have 
failed. 

SUDORIFICS. 

Sudorific s have, as well as emetics, been frequently com- 
mended, and employed in the treatment of the Yellow Fever i 
I cannot, however, join in this commendation, for the follow- 
ing reasons ; 1st. They do not seem to be at all necessary, 
because a natural perspiration will readily ensue as soon as 
the excess of heat above the standard of health has been re- 
moved, which can be accomplished with certainty by the 
proper application of cold water to the surface of the body. 
2dly. The means by which a perspiration is to be excited are 
not altogether innocent. Small doses of such sudorific medi- 
cines as, when given in large quantities, prove emetic, tend to 
increase that disposition to vomit, from which, as I have just 
mentioned, the greatest danger is always to be apprehended ; 
and of this class of sudorifics none are so detrimental in the 
Fevers of hot climates as preparations of antimony, because, 
aided by the natural operation of heat, they usually leave be- 
hind them an extreme degree of irritability in the primse vise, 
which but too often resists all our endeavours to appease it. 
Again, if the sudorifics be composed of medicines of the above 
class, combined with opium, as Pulvis Ipecacuanhse composi- 
tus, some share of that irritability will still be produced, 
though less, indeed, than in the former case; and the first 
effects of this combination will generally be a morbid increase 
in the heat of the body, and a greater determination of blood 
to the head, which may soon be followed by delirium or coma. 
Moreover, medicines of this description do not always succeed 
in causing perspiration ; and if they fail in this respect, they 
will probably produce other effects very injurious to the pa- 
tient, such as aggravating the existing symptoms, and length- 
ening the paroxysm. 






12 



PERUVIAN BARK AND CORDIAIS. 

By the means above-mentioned, joined with mild febrifuge 
remedies, as saline draughts in an effervescent state, and by 
such others as will mitigate the sufferings of the patient, we 
may confidently hope, either that the termination of the first 
paroxysm will also terminate the disease, or at least, that the- 
brain and the stomach will have been so far protected as to 
obviate the dangerous consequences of the succeeding stages ; 
and in this expectation we may begin, as soon as the febrile 
commotion subsides, to administer the Peruvian Bark, in such 
form of preparation, and in such quantity, as will best suit 
the state of the stomach, in order* to restore that organ \6 
its proper functions, to strengthen the system, and to prevent 
any return of the Fever. It should, however, be a rule not 
to give bark in this disorder till the period just mentioned ; 
for if it be given when there is a parched skin, a hard pulse, a 
dry tongue, great heat and pain at the stomach, or delirium, 
it will generally be found to increase and prolong these symp- 
toms. 

When the patient begins to sink in strength, lie should be 
supported by combining aromatics with the bark, and also by 
wine more or less diluted, or even brandy, which is often more 
palatable and more easily retained by the stomach than wine; 
and these cordials should afterwards be continued, or increas- 
ed according to the state of Ms stomach, and the degree of his 

* Dr. John Clarke, after a review of the practice in Fevers, as contained in Uk 
journals of the Surgeons of the different ships in the service of the East India Company, 
between the years 1770 and 1785, has given the result thereof in the following word*, 
at page 468 of his valuable work on the diseases of long voyages. " Upon the w hole of 
the evidence it appears that, when Fevers of any consequence prevailed in the ships, 
either at sea, or at the different stations in India, mortality was al most invariably the 
consequence of bleeding, and the continued use of purgatives and antimonials. 
under a cordial regimen, and moderate evacuations, succeeded even by a late ■ 
the bark, many recovered ; and that under the early, liberal, and continued use 
medicine, not one instance of death is recorded." 



73 

debility. If the extremities grow cold, they should be warmed 
by artificial means. 

MERCURY. 

It will doubtless be expected that I should speak of saliva- 
tion by Mercury in the Yellow Fever, which some writers 
have so highly extolled 5 and, indeed, I should have done it 
earlier, if the results of my former experience, or a satisfac- 
tory explanation of its mode of operation, had relieved me 
from the doubts and difficulties which I have felt on this 
subject. 

Dr. Henry Warren, in his " treatise concerning the Malig- 
nant fever in Barbadoes," (for so he called the Yellow Fever) 
first printed in 1740, after condemning what he designates as 
** a very odd, and unwarrantable practice which had obtained 
for many years among*several of the plantation practitioners 
in that island, of giving calomel in Inflammatory Fevers, 5 * 
says, (at page 36) " I have yet never heard of mercury being 
given in this malady, (Yellow Fever) and I hope I never shall ; 
as, no doubt, it would here act an uncommon mischievous 
part." It was not then foreseen that, in the year 1793, a 
medical practitioner in Grenada would be found boldly ad- 
ministering mercury in this very disease, even so as to excite 
copious salivation, because he supposed, erroneously, * that 
" the liver was the most diseased part," and had heard of two 
Surgeons of the army who, some years before, gave calomel with 
success in the Yellow Remittent Fever, not indeed to salivate, but 
to produce evacuations by stool ; and also, because he thought 
that " it was, at all events, better to try a doubtful one, than 
remedies of no efficacy." Although I should not have thought 
these motives sufficient to warrant an innovation so extraordi- 
nary, yet if it has really preserved even a few of the lives said 

* See pages 351 and 423 of Vol. 1, of Dr. Chisholm's Essay on the Malignant Pesti- 
lential Fever, &e. 

10 



74 

to have been saved thereby, I shall most readily excuse the 
acknowledged " temerity" of that new practice, and sincerely 
rejoice at the practitioner's good fortune in thus stumbling 
upon an efficacious remedy for a disease commonly productive 
of so much mortality. I must, however, acknowledge, that I am 
not yet convinced of the supposed benefits of this new practice ; 
for, should it even be true, as is pretended, that the patients 
labouring under Yellow Fever, in whom a salivation can be 
excited, generally recover, I do not perceive that we could 
thence fairly infer, that their recovery was effected by the sali- 
vation. It is well known that, in many cases of that disorder, 
more than 500, and, in some, more than 1000, grains of calo- 
mel have been given internally to a single patient without 
producing any sensible effect on the salivary glands, or even 
on the intestines ; and although, to explain this inactivity of 
the mercury, it has been supposed, that in sucli cases the ab- 
sorbents alone were in fault by not taking up the mercury, 
this explanation cannot be admitted, because the intestines 
have commonly been as little excited by the calomel thus in- 
troduced as the salivary glands ; and it seems, therefore, pro- 
bable that a general torpor, or defect of excitability, and of 
vital energy, existed in such patients,* and that the mercury 
proved inefficacious in them only, because they had already 
made considerable approaches towards the condition of a dead 
body, in which it is obvious that no quantity of that medicine, 
however large, could exercise a stimulant power. If this rea- 
soning be just, there will be room to suspect at least, if not to 
conclude, that, when patients die of Yellow Fever, after all 
attempts to excite salivation in them have failed, their deaths 



* Dr. Chisholm, after mentioning: (at page 429 of Vol. 1, of his Essay) that there are 
some habits which, under the influence of diftase, resist the action of mercury even 
•when more than 2000 grains have been given, while there are others in which saliva- 
tion is excited by less than ten grains, adds, "hence it may not be irrational to conclude, 
that the susceptibility of, or resistance to, the action of mercury in habits, in which the 
morbid action of the cause of the Malignant Pestilential, and Yellow Remittent Fever* 
has already taken place, are in the direct ratio of their excitability ,•" a conclusion tha 
« in conformity with the explanatiou wliich I have above given. 



15 

have resulted, not from the want of any good effect which Sali- 
vation may be thought capable of producing, but because the 
condition of their living, or sensorial power, and of the func- 
tions depending thereon, had already become so morbid as to 
render their recovery impossible ; and, on the other hand, that 
where persons have recovered from the Yellow Fever, after 
having been salivated, their recovery was not occasioned by 
the salivation, but was the consequence of such a condition of 
the powers of life, and of the functions connected therewith, 
as induced a mitigation of the disorder, for the same reason, 
and perhaps, cseteris paribus, in the same degree, as it favour- 
ed the operation of mercury upon such persons ; and therefore 
that, although recovery has not unfrequently followed, or ac- 
companied salivation, the latter was not a cause of the former. 
There is, indeed, no source of error more common or produc- 
tive, than that of supposing an event which closely follows 
another to have been occasioned by it ; and it may be doubted, 
whether a great number of the advocates for mercurial saliva- 
tion in the Yellow Fever have any other, or better, foundation 
for their conviction of its efficacy. 

Besides the uncertainties in the operation of mercury, which 
depend on the different conditions, or degrees of the general 
excitability, there are others, arising from certain constitu- 
tional peculiarities not well understood, which give occasion 
to excessive salivations by the taking of only a few grains of 
calomel ; and this effect constitutes a serious objection to the 
use of mercury, in a disease so rapid and dangerous, without 
manifest necessity. 

In order, however, to attain the truth upon this important 
subject, it is not sufficient for us to discover, that recovery 
generally follows salivation in Yellow Fever, though even this 
is contradicted by many very respectable authorities ; but we 
must ascertain whether those practitioners who excite saliva- 
tion in as many of their patients as may be susceptible of it, 
under that disorder, do in fact lose a smaller proportion of 
them, than those who purposely abstain from all endeavours to 



76 

pi'oduce that discharge : and on this point I must declare that, 
after some experience, assisted by no ordinary portion of in- 
quiry and information, I have not been able to discover that 
the salivators were more successful than the others. And, if 
not more successful, their practice has certainly been hurtful ; 
because, in most of the persons who have recovered, the (per- 
haps useless) salivation had retarded the convalescence, and 
produced very troublesome affections of the tongue, mouth, 
and throat, with other ill consequences ; as is well known and 
acknowledged, even by its advocates. Dr. Chisholm (at page 
357, of vol. i. of his Essay,) warmly acknowledges his "obli- 
gations to Dr. Rush for supporting in a masterly manner," 
. and "pursuing the mercurial mode of treatment," and express- 
es both " admiration and respect" for his u fortitude" in doing 
so. But Dr. Rush, notwithstanding this support and this for- 
titude, has candidly stated, that * in the City Hospital, (of 
Philadelphia) where bleeding was sparingly used and where 
the physicians depended chiefly upon salivation, more than one- 
half died of all the patients who were admitted." — (See page 
128, of vol. v. of his Medical Inquiries and Observations.) — 
But great as this mortality was, it fell vastly short of that 
which occurred in a detachment of the Royal Artillery, placed 
under the care of Dr. Chisholm, when of twenty-seven re- 
cruits for that corps, who arrived in Grenada, in July, 1793, 
twenty-six were seized witli the Fever, and of these,* twenty- 
one died before the middle of August ensuing, that is, in six 
weeks. (Seepage 133, of vol. i. of Dr. Chisholurs Essay.) — 
Upon the subject of this occurrence. Dr. John Hunter has ob- 

* Among the cases given by Dr. Chisholm, in his first Appendix, the four which are 
numbered 9, 13, 14, and 15, (See pages 371, 3S3, 3S6, and 5S7, of vol. ii ) seem to be 
the cases of four out of the five sui-vivors of the twenty-six men in question ; and it is 
remarkable that in the two first of those cases very little mercury was administered, 
but the Pei-uvian Bark, with some opium, wine, &c was chiefly relied upon for tke 
cure ; and that in the two last, no mercury -whatever -.vat girvn. The twenty -five 
cases, therefore, before us, and their lvsults, appear by no means to correspond with 
Dr. Chisholm. 's high commendation of, or professed confidence in, the mercurial treat- 
ment. 



77 

served, (at page 328, of his work on the Diseases of the Army 
in Jamaica,) that although "Dr. Chisholm had satisfied him- 
self of the great virtues of Mercury, at least four months be- 
fore, yet this is a mortality never exceeded in any Fever."* 

To one who is sincerely desirous of discovering and adher- 
ing to the truth, it is extremely difficult to reconcile, or ac- 
count for, the very opposite testimonies given on this subject ; 
and the doing it would moreover be too invidious for me to at- 
tempt it. This, however, appears certain, that the good ef- 
fects of the mercurial treatment have been greatly exaggera- 
ted by persons who either were deceived, or were willing to 
deceive others ; that many persons have died of the Fever in 
question, although mercury, administered externally or inter- 
nally, had produced a copious salivary discharge ; and that, 
in very many others who have recovered, this discharge did 
not beginf until after a solution, or a great mitigation, of the 
disease had evidently taken place, which solution, or mitiga- 
tion, therefore, could not have been the effect of salivation. — . 
I cannot, with an eminent and respectable physician,:): who 
treats of this practice, " aver that, although I have been called 
in to attend many under such circumstances, not one survived, 



• Dr. Chisholm, who was likewise attacked by the same Fever in the same year, was 
himself more fortunate ; for though he had recourse, at first, to the same remedy, he 
became convinced of its inefficacv, in his own case, early enough to call for the advice 
of Dr. William Munro, then of Grenada, and now of Demerary, under whose care he 
recovered, but, as I have been well informed, by a very different mode of treatment. 

Dr. Chisholm, at page 237-9, of his second volume, mentions the great success of the 
mercurial treatment in the hands of his former partner in Grenada, Mr. W. Campbell; 
yet, as I have been assured from respectable quarters, this gentleman refused to take 
Calomel, when he was afterwards attacked by the Yellow Fever, of which he died. 

f " Mercury seldom salivated untd the fever intermitted or declined. I saw several 
cases in which the salivation came on during the intermission, and went off during its 
exacerbation; and many n which there was no salivation until the morbid action had 
©eased altogether in the blood-vessels, by the solution of the fever." — See Dr. Rush's 
Account of the Bilious Yellow Fever of Philadelphia, in 1794, in the 4th vol. of his 
Medical Inquiries and Observations, page 94. 

* See the "Essay on the Yellow Fever of Jamaica, by David Grant, M,D.' ? 
page 51. 



78 

and that they became more victims to the mercury than even 
to the Fever f 9 but I can aver, that I had not a few opportuni- 
ties of observing the effects of mercury given in this disease, 
while I served, in 1796 and 1797, as physician to the army, 
under Sir Ralph Abercrombie, in the West Indies ; and that 
I saw nothing, which, to my understanding, could afford a 
proper encouragement to continue the mercurial practice ; and 
this, I have great reason to believe, may be said of most of 
the other physicians and medical officers, who were then, or 
have been subsequently, employed with the British forces in 
the West Indies ; and therefore, though I have adopted no in- 
vincible, nor, as I hope, unreasonable, prejudice on the sub- 
ject, I cannot venture to recommend the use of mercury to 
excite salivation in Yellow Fever, without farther evidence of 
its utility. At the same time, I consider the use of it, in this 
disorder, as a purgative, to be highly beneficial. 

Of mercurial frictions, which have been largely employed 
in the Yellow Fever, it may also be observed, that they do 
not seem likely to prove altogether innocent in those cases in 
which they may happen to do no good ; for, besides the sali- 
vation which they may produce, when the patient lives long 
enough, and which is to be added to the number of his suffer- 
ings, already sufficiently abundant, the very act of rubbing-in 
the mercury tends greatly to disturb his body and mind, when 
his only wish is to remain unmolested ; while the covering a 
large portion of the skin with a greasy ointment produces a 
considerable accumulation of heat therein, by which the gen- 
eral heat of the body, and with it many of the other febrile 
symptoms, will be increased. 



END OF PAKT FIRST. 



PART SECOND. 



Having given some account of the symptoms and treatment 
of the Yellow Fever, it seems expedient, as far as possible, to 
ascertain its cause : but in attempting to do this, I find the 
natural course and progress of my inquiry obstructed by cer- 
tain doctrines, taught by authorities highly respectable, and 
almost generally adopted, though, as I think, without sufficient 
evidence ; and I am, therefore, induced to enter upon a pre- 
vious examination of these doctrines, in order to remove the 
obstruction occasioned by them, and clear a path which will, 
I hope, lead towards the truth. 

To render this examination the more methodical and satis- 
factory, I beg leave to propose, for discussion, two problems, 
to which the doctrines in question seem to be referable, viz. — 
First, Are all fevers naturally contagious, or capable of ex- 
citing fever in other persons not predisposed thereto ? 

Secondly, Can a fever, strictly contagious, be generated by 
an accumulation of filth, or of putrifying, or putrid matters, 
or by the crowding of healthy persons into confined, or ill- 
ventilated, and unclean places ? 

The affirmative of the first of these problems has been as- 
serted by Dr. Cleghorn,* Dr. Robert Hamilton,! Dr. John 
Clarke,:): and more especially by the late Dr. George Fordyce. 
The last of these authors, in his Dissertation on Simple Fever, 

1 

* Observations on the Epidemical diseases of Minorca, third edition, page 132, &c. 
f Observations on Marsh Remittent Fever, page 39, &c. 

+ Observations on the Diseases which prevail in Long Voyages to Hot Countries, 
vol. i. page 151, &e. 



80 

(page 113 and 114, second edit.) endeavours to maintain, that 
" by repeated experience, it is now known that, although it 
very frequently happens that a man coming near another 
afflicted with fever, is not afterwards affected with the disease, 
yet of any number of men, one-half of whom go near a person 
ill of this disease, and the other half do not go near a person 
so diseased, a greater number of the former will be affected 
with fever, than of the latter, in a short period afterwards. In 
some instances, the proportion is not very different ; in others, 
the author has known seven out of nine, who went near a per- 
son afflicted with fever, seized with the disease, in the space 
of three weeks afterwards. There is, therefore, (adds he) a 
perfect ground, from experience, for believing, that coming 
near a person afflicted with fever is a cause of the disease."' 

This general indiscriminating assertion, if it were true, 
could only prove that some fevers are contagious, — not that 
all are so. — But the assertion is manifestly founded upon a 
supposed probability, or presumption, that such effects would 
result from the causes here described ; for no one can believe, 
that an actual experiment was ever made by selecting a cer- 
tain number of persons, and sending one-half of them into 
close communication with a febrile patient, and afterwards 
contrasting what happened to these, with the condition of those 
who were not allowed to approach any person labouring under 
fever. Nor would a single experiment afford any conviction 
on this subject, for reasons too obvious to require explanation. 
Much also would depend on the species of fever to which the 
individuals in question are supposed to have been exposed, 
which is not mentioned by Dr. Fordyce. Few persons, if 
any, doubt of the contagious quality of what is called Jail 
Fever, and few believe that intermittent fevers possess that 
quality. 

The same author, at page 116, inculcates that •• a peculiar 
matter is probably generated in the body of a man in fever, 
which, being carried by the atmosphere, and applied to some 
part of the body of a person in health, causes a fever to take 



81 

place in him." This matter having no sensible properties, 
** its existence (says he) is only known by its effect in pro- 
ducing the disease." And in the next page he asserts, that 
** this infectious matter is produced by all fevers whatever ;" 
but immediately adds, that, *• as far as he knows, no person 
has been seized with fever, in consequence of coming near 
another person afflicted with it, where the fever consisted of 
one paroxysm only ;" and he thereby, in effect, admits that he 
has gone beyond his knowledge, and contradicted his own 
uniform experience, in asserting that " this infectious matter 
is produced by all fevers whatever." And probably, if he 
had examined facts with sufficient accuracy and caution, he 
would have discovered that other fevers, beside those of one 
paroxysm, had occurred, which were not known to have ever 
re-produced fever in any other person. 

In the same page, Dr. Fordyce declares, " that Intermittent 
Fevers produce this matter, or, in other words, are infectious ;" 
and that he " knows this from his own observation, as well as 
that of others." 

Here again the author seems to have hazarded an assertion, 
for which it is hardly possible that he could have had any 
certain foundation, because it is now known, as will be more 
fully stated 'hereafter, that the ordinary, and perhaps sole 
cause of intermittents, i. e. Marsh* miasmata, may remain 
inactive for several months after having been imbibed by a 
person in health, and, finally, produce fever, notwithstanding 
such long inactivity ; and therefore, although Dr. Fordyce 
may have known persons to be attacked by intermittents, after 
having communicated with others labouring under that disor- 
der, he could never have been certain that they had not, with- 
in the preceding six or eight months been exposed to these 



* I beg to state, m this place, that, in joining the epithet tnarsh, or marshy, to the 
terms miasmata, exhalation?, effluvia, &c. and in considering these as a cause of fever, 
I do not mean to intimate that such miasmata, &c. are emitted solely by marshes, (it 
being certain that they frequently arise from soils in a different state,) but only to desig- 
nate the quality of those vapours, which are eminently the product of marshy grounds; 

11 



82 

miasmasta, existing, as they do, in a variety of unsuspected 
places. He seems, indeed, to have been less confident in re- 
gard to these than in regard to other fevers, for he immedi- 
ately subjoins the following concession, viz. — " But intermit- 
ting fevers are not nearly so apt to produce it, (the conta- 
gious matter,) or at least, to propagate it, as continued fevers ; 
and the more violent the continued fever is in its febrile symp- 
toms, the greater quantity of infectious matter is produced." 

This general assertion of the contagious nature of all IV 
without exception, is so important in the conclusions deduci- 
ble from it, and so much at variance with the general experi- 
ence of mankind, more especially in regard to thosi 
which so frequently follow any considerable exposure to the 
exhalations of marshy, or damp, soils during, or soon after, 
very hot seasons, that I feel it incumbent on me to contest this 
assertion : and in doing so. I beg leave to observe, that tin- 
kinds of evidence, which would be sufficient to produce convic- 
tion in a Court of Judicature respecting the ordinary transac- 
tions of our lives, would often prove fallacious in regard to 
medical facts, and especially those, which relate to the t 
ence and effects of contagion ; — the former being cognizable 
by some of our senses, we are enabled to ascertain and testify 
the truth concerning them ; but this rarely happens in reg 
to the latter : of which our belief frequently depends upon sup- 
posed causes and effects, whose existence and relations are 
not capable of being either seen, heard, or felt ; and yet men 
will frequently imagine they have seen, heard, or felt, all that 
is necessary to warrant their belief ; and will, in such < . 
even assert what appeal's to them to be true as confidently as 
if their judgment had not been, in any degree liable to error. 

Hence the works of medical writers abound with supposed 
facts, which are now known to have been more or less falla- 
cious ; and to this source of error, all proofs of the existence 
of contagion are particularly liable ; because the matter, of 
which it consists, is not distinguishable by any of our sen 
and we can, therefore, only presume its existence and ageno 



83 

by certain effects or events, which may he suspected, but can 
hardly ever be absolutely proved, to have resulted from it. — 
Aware of this difficulty, Dr. Haygarth has very properly made 
a distinction between facts adduced to shew the existence of 
contagion, from the circumstance of certain persons having 
been attacked by a particular disease, which last he names af- 
firmative proofs ; and other facts shewing the non-existence of 
contagion, from a number of persons having escaped the disor- 
der, who had been fully exposed to the action of effluvia, sup- 
posed to be infected ; these he calls negative proofs. " Obser- 
vation, or experiment," says he, " can determine with much 
greater certainty what does not, than what does, give infec- 
tion ;" whence he justly concludes, that the negative proof is 
capable of being established by incomparably stronger evi- 
dence than the affirmative, and is therefore, in all cases, much 
better entitled to credit."* 

Indeed, Dr. Fordyce maintains, page 110, of his first Dis- 
sertation, that, " in treating of Fevers, nothing is to be ad- 
mitted as a cause, the knowledge of the action of which does 
not depend upon experiment;" and he observes, at page 112, 
that, " of the number of causes to which fever has been ascri- 
bed by the practitioners who have treated of this disease, few 
will bear the test of any strict inquiry:" — an observation 
which will I think, hereafter appear applicable to more than 
one of the causes of fever, which have been supposed by Dr. 
Fordyce himself, notwithstanding the great merit of his wri- 
tings in many other respects. If contagion be a quality natu- 
rally belonging to all sorts of fevers, without distinction, they 
ought all to manifest this property in circumstances favourable 
to, and upon persons susceptible of, its action. That there are 
fevers, however, which do not manifest this property, or qua- 
lity, in circumstances highly favourable to its operation, and 
upon individuals who must have been fully exposed to, a? 



* See his letter to Professor Waterhoase, at page 296, of his " Plan for exterminat- 
ihg the Small Pox." 



84 

well as susceptible of, its impressions, if such contagion had 
existed, may be demonstrated by hundreds, and probably by 
thousands, of well-authenticated facts, capable of infinitely 
overbalancing the supposed evidence derived from occurren- 
ces, in most of which it was easy to mistake, for the effects of 
personal contagion, those produced by morbid causes existing 
in the atmosphere, and derived from very different sources. 

It will, however, be sufficient to adduce a few only of these 
facts at present, especially as I shall have occasion hereafter 
to mention a variety of others, of similar import, though for a 
different purpose. 

Dr. James Land, in his Essay on the Diseases incidental to, 
Europeans in Hot Climates, (p. 27, fifth edition,) states the 
following fact, — viz. 

" In the month of August, 1758, Admiral Broderick, in the 
Prince ship of war, anchored in the Bay of Oristane, (in Sar- 
dinia) where twenty-se\en of his men, sent ashore on duty, 
were seized \>ith the epidemical distemper of this island; 
twelve of them in particular, who had slept on shore, wert 
brought on board delirious ; all of them laboured under a low 
fever, attended with great oppression on the breast, and at 
the pit of the stomach, — a constant retching, and sometimes a 
vomiting of bile, upon which a delirium often ensued. Those 
fevers changed into Double Tertians, and afterwards termina- 
ted in obstinate Quartan Agues. It is worthy of remark, that 
in this ship, which lay only two miles distant from the land, 
none were taken ill but such as had been on shore, of whom 
seven died." 

The same respectable author, at page £21, mentions ano- 
ther similar fact in the following terms, — viz. 

«* In a voyage to the Coast of Guinea, performed in th« 
year 1766, by the Phoenix ship of war, of forty guns, the offi- 
cers and ship's company were perfectly healthy, till, on their 
return home, they touched at the Island of St. Thomas. — 
Here the captain, unfortunately, went on shore, to spend a 
few days in a house belonging to the Portuguese governor of 



85 

4hat island. This happened during the rainy, or sickly, sea- 
son. In the same house were lodged the captain's brother, 
the surgeon, some midshipmen, and the captain's servants. — 
But in a few days after their being on shore, the captain, his bro- 
ther the surgeon, and every one, to the number of seven, who had 
slept in that house, were taken ill ; and all of them died except 
one, who returned to England in a very ill state of health. — 
The ship lay at anchor there twenty-seven days, during which 
time three midshipmen, five men, and a boy, remained on 
shore, for twelve nights, to guard the water casks, under pre- 
tence that the islanders would steal them ; all of whom were 
likewise taken ill, and two of them only escaped with life.— 
At that island, only those who slept on shore were taken ill ; no 
other man of the ship's company was seized with any distem- 
per during their stay there. Even during the whole voyage, 
if we except these unfortunate persons, only one man died, 
and he was killed by an accidental blow upon the head. — 
None of those who slept on shore escaped the sickness, and 
of them only three survived it." And, at page 225, he adds, 
"In the year following, the Phoenix made another voyage to 
the Coast of Guinea, and happened again to touch at this isl- 
and in the sickly season, where she lost eight men out of ten, 
who had imprudently remained all night on shore. At the 
same time, the rest of the ship's company continued in perfect 
health, who, after spending the greatest part of the day on 
ghore, always returned to their ship before night. On board 
the Hound sloop, then in company with her, only one man 
died during the whole voyage ; the officers having been parti- 
cularly careful not to permit any of the people to continue all 
night on shore in that place. This man was cut off by an ob- 
stinate intermitting fever, with which he had been first seized 
at Sheerness." 

The same author, in his " Essay on the most effectual 
means of preserving the health of Seamen," had previously 
observed, at page 57, "that the fever of the Island of St. 
Thomas, is, to a proverb, in that part of the world, deemed 



86 

the most malignant and fatal species of any African or Ame- 
rican Fever ;"* and consequently, if Dr. Fordyce's doctrine 
•were true, that all fevers are more contagious according as 
their symptoms are more violent, this fever ought to have 
been communicated to great numbers on board the Phoenix, 
whose intercourse with the sick in that ship must have been 
sufficiently near and frequent. The same want of contagion 
has, however, attended this fever on other, and, so far as I 
know, on all other occasions. 

Dr. Trotter, late physician to the Royal Navy says, (See 
Medicina Nautica, vol. i. page 456.) " In a voyage down the 
Coast of Guinea, in the Assistance, in the year 1762, we had 
scarcely a man indisposed. We wooded and watered at the 
Island of St. Thomas, and witli a view to expedition, a tent 
was erected on shore, in which the people employed on these 
services were lodged during the night. On the middle pas- 
sage, every man who slept on shore died, and the rest of the 
ship's company remained remarkably healthy.'' 

Of a similar nature are the facts which occurred in regard to 
the Ponsborne and Nottingham East Indiamen, at the Como- 
ra Islands ; (See Medical Observations and Inquiries, vol. iv. 
page 156,) atone of these islands, viz. Mohilla, a great part 
of the crew of the former ship, after sleeping on shore in Au- 
gust, 1765, were attacked by a violent fever, which, in a few 
weeks, proved fatal to more than seventy of them ; and, on the 
16th of July of the following year, the Nottingham having an- 
chored to the leeward of Johanna, (another of the Comora Isl- 
ands,) and a considerable part of her crew having been sent, 
and allowed to sleep, on shore, they were attacked, soon after 
the ship had put to sea, by a severe remitting fever, of which 

* Of the Island of St. Thomas, Dr. Robertson, Physician to Greenwich Hospital, 
observes, page 32, of his Meteorological and Physical Observations, &c. 4to. that " the 
town is built on the leeward-most part of the island, which is not at all cleared of th« 
woods, nor the niarsh drained ; the consequence of which is, it is generally peopled 
from Portugal ever}- second year, it proves so fatal to Europeans " For another proof 
of the danger of sleeping on shore on that island, see pages 53 and 98 of the same work. 



87 

several died. Of this fever, Dr. Badenoch, then surgeon oi 
the Nottingham, observes, " it infected only those that slept on 
sJwre 9 and having gone through them, the fever ceased." And 
this he adds, " was likewise the case with those on hoard the 
Ponsborne, in regard to the Bilious Fever, which prevailed in 
that ship, at the island of Mohilla." 

A similar occurrence is related by Dr. John Clark, in the 
first volume of his Observations on the Diseases which prevail 
in Long Voyages to Hot Countries, page 124; after descrir 
bing the low place, " covered with impenetrable mangroves," 
at North Island, near the Streights of Sunda, where most of 
the East India ships take in wood and water for their home- 
ward voyage, he adds, that " a Danish ship, in 1768, anchor- 
ed at this Island, and sent twelve of her people on shore to fill 
water, where they only remained two nights. Every one of 
them were seized with a fever, of which none recovered ; but 
although the ship went out to sea, none, except the twelve who 
slept on shore, were attacked with the complaint." Here 
again was a fever so violent as to kill every one in whom it 
was excited, and from a cause so powerful as to affect every- 
one who was exposed to it, which, notwithstanding, did not 
reproduce itself in a single instance. 

Many facts and occurrences, of a similar nature, might ea- 
sily be added to the preceding ; but they are all rendered su- 
perfluous by the notorious and unfortunate events, which have 
recently happened among the British officers and soldiers em- 
ployed in Zealand, among whom, though near thirty thousand 
of them were attacked by fever, which proved fatal to nearly 
one-sixth of the whole number of sick, I have not been able, 
after much inquiry, to discover a single case, in which there 
has been reason to suppose, that any one person caught the 
fever from another. But, on the contrary, it appears to be 
the unanimous opinion of the army physicians employed on 
that service, (with most of whom I have conversed on the sub- 
ject,) and also of the other medical officers, best qualified to 
judge of such matters, that no contagious quality accompanied 



88 

the fever in question, either upon the island of Walcheren, 
or among the sick removed to this country. And I shall 
hereafter adduce the most convincing evidence, that in fact, 
these fevers were not of a contagious nature ; and we may, 
therefore, consider ourselves as abundantly warranted in 
concluding, that all fevers are not endowed with a contagious 
quality, which conclusion is all that I propose to establish at 
present 

Problem II. Can a Fever, strictly contagious be generated 
by an accumulation of filth, or of putrefying, or putrid, mat- 
ters, or by the crowding of healthy persons into confined, or 
ill-ventilated, and unclean places ? 

Most writer* on the subject of Contagious Fever have ei- 
ther inculcated or believed, that it might be generated, — first by 
an accumulation of those disgusting matters, commonly de- 
nominated filth ; — secondly, by the offensive vapours emitted 
by corrupting dead bodies, or by other matters in a putrid 
state ; — and, thirdly, by crowding persons, even when heal- 
thy, in ill-ventilated and unclean places. 

I have no desire to weaken any of the prejudices which tend 
to promote cleanliness in civilized nations, any further than 
is absolutely necessary for the manifestation of truth, on a 
question of great importance to mankind ; and I flatter my- 
self that we shall all find within ourselves sufficient motives 
to remove or avoid filthiness, even when convinced that it 
does not produce contagious fever. Whence the belief of its 
doing so was derived, I am unable to explain ; but it has pro- 
bably been confirmed by the frequent co-incidence of such fe- 
ver, with nastiness and offensive smells in the dwellings of 
indigent people. There is, however, no necessary, or natural 
connexion between the former and the latter. 

Dr. Fordyce asserts, (first Dissertation, page 115,) that he 
has known persons to be ill of the most infectious fevers, and 
to communicate fevers to others by infection, when there was 
no peculiar smell nor taste, nor any thing perceptible to the 
senses in the atmosphere surrounding them ; and similar as- 



89 

sertions have been made by Dr. Lind, and others, which I be* 
lieve, are in conformity with the experience of all physicians* 
I know, indeed, that masses of animal and vegetable matters, 
and especially the former, while undergoing putrefaction, or 
other modes of decomposition, as in privies, &c. may give out 
vapours so condensed and noxious as to cause asphyxia, and 
sometimes almost immediate death, to those by whom they 
•are inspired. But such mischiefs have no relation to fever ; 
nor are those who recover from them, afterwards affected, in 
consequence thereof, by any febrile disorder. This is also 
true of the dangerous, and often fatal, effects produced by the 
fumes of charcoal, and the mephitism of mines, long-neglect- 
ed wells, &c. which are not known to have ever produced fe- 
ver ; these do not however, properly relate to our present in- 
quiry. 

Every thing which I have been able to discover, or ascer- 
tain, respecting the nature and properties of contagion, in- 
duces me to consider each of its several species as a peculiar 
morbid quality, or power, imparted to certain animal secre- 
tions, in consequence of some particular, though unknown, ac- 
tions excited in the living body, when actually disordered, by 
the very same species of contagion previously, and in like 
manner, elaborated in another body, whilst labouring under a 
similar disorder from a similar cause ; and therefore, though 
we are unacquainted with the origin of any one species of con- 
tagion, yet, considering the properties manifested by all, 
ever since they have been known to exist, we may conclude, 
that being thus produced, exclusively by, and within, the liv- 
ing body, each is capable of exciting, in other living bodies, 
the same morbid action, or disease, which occasioned its own 
production, and of thus maintaining and propagating itself in- 
definitely ; and consequently, that though contagion be a mor- 
bid and morbific secretion #r production, it is also a natural 
one, wholly, inimitable, either by accident or art. If this be 
true, it must follow that, though noxious vapours should result 
from those fortuitous, and ever varying, collections ox unclean 

12 



I 



90 

or putrefying matters commonly denominated filth, which, a* 
in the instance of marsh effluvia, may produce diseases, inclu- 
ding fever, yet the diseases so produced will be incapable of 
exciting similar diseases in other persons, and will, therefore 
be destitute of the most essential property of contagion. 

Indeed, if it were true that vegetable or animal matters, 
while decomposing or putrefying, could de novo generate con- 
tagion properly so called, the species or varieties of contagion 
ought necessarily to have become as numerous and various as 
the matters so decomposing, and also as various as their re- 
lative proportions ; — every dunghill, every collection of rub- 
bish and filth, ought to be capable of generating the cause of 
a new disease, and that disease ought to be capable of repro- 
ducing itself in other persons ; and human existence, with such 
additions to the other dai geis which surround us, ought to 
have become the most precarious, transient, and deplorable, 
of all the works of creation. 

No person, who is even moderately acquainted with the 
subject, can believe that a disorder resembling Small Pox, 
(for instance,) and possessed of the same properties, could be 
created by any accidental collection, or even by the most ar- 
tificial and scientific combination, of either organic or inor- 
ganic matters, not impregnated by the specific contagion of 
that disease. On the contrary, we have the strongest reason 
to believe that neither human ingenuity, nor any co-operation 
of natural means, could even alter the nature of variolous con- 
tagion ; and that, in fact, it has continued, w ithout any last- 
ing change in its properties, ever since that unknown aera 
When its morbid action was first exerted upon mankind ; 
though, having been successively transmitted through the bo- 
dies of, perhaps, several hundred thousands of individuals of 
different colours and temperaments, many of them probably 
contaminated at the same time byscrophula, syphilis, cancer, 
or other morbid taints, or infections, (and tliis, during the 
prevalence of numerous cp demical or pestilent disea- 
these ought, if any tiling could, to have produced every do 



91 

gree of deterioration, of which the original virus was suscepti- 
ble, and some permanent varieties, at least in this species of 
contagion.* We know, however, that its specific properties 
are invariably the same, and that the differences which are ob- 
served in its effects, depend upon causes connected with the 
individuals to whom it is respectively applied ; the disease, 
cseteris paribus, proving no worse, when communicated by 
one dying of it in the most confluent and malignant form 
than it would have been,f if communicated by one recovering 
from the mildest product of inoculation. And we have simi- 
lar reasons for believing that Measles, Chicken Pox, and 
other specific contagions, are equally permanent and unaltera- 
ble. If then the powers of life, and the organs by which 

* Dr. Adams, physician to the Smal! Pr>x Hospital, observes, at page 21 of his work 
on morbid poisons, in 4to. that, from the great affinity, or analogy between the vario- 
lous and vaccine contagious, " we might even expect that the characters ot the two 
might he altered, by applying both at the same time, and also that the phenomena of 
one might imitate the phenomena of the other, in such a manner as to render the dis- 
tinction between them doubtful. It is, therefore, a matter of surprise, that the distinct 
tion should be so regularly observed, and the laws which separate other morbid poisons 
be so rarely infringed." 

He also remarks, at page 598, that " Small Pox and Cow Pox, contrary to the law of 
all morbid poisons, which are different in their nature, will proceed together in the 
same person without the smallest interruption of each other's course. If inserted 
nearly at the same time in the same person, each proceeds in the same course as if 
they were in two distinct subjects ; if inserted nearly in the same spot, the two form 
tne common areola, but the vesications are distinct, and each preserves its own charac- 
ter, till that of Small Pox becomes purulent from suppuration," &c. In this case, he 
ad 's, " you may take Small Pox matter from the pustule, which, by the adhesive in- 
flammation, will remain distinct from, though seated in part of the Vaccine Vesicle ; 
and from the other parts of the Vesicle you may take vaccine matter, and each will 
perpetuate its respective morbid poison." 

Thus we find that, by the simultaneous association of two infections, so nearly alike, 
that the action of the one renders the body insusceptible to the action of the other, the 
energies of the constitution cannot produce even an intermediate, or hybrid contagion. 

f At page 10, vol. i. of the Transactions of a Society for improving Medical and Chi- 
rurgical knowledge, Dr. G. Fordyce says, " I have the greatest reason to believe, that 
it is not of the smallest consequence, (in inoculation) whether the matter be of the mild 
or the confluent kind. I never knew of an instance of any other disease being commu- 
nicated by inoculation of the Small Pox." 



92 

these contagions are successively renewed and perpetuated, 
cannot even alter the qualities or effects of the latter, by any 
of the changes which may be supposed to have taken place in 
their actions and in the fluids of the human body, from a va- 
riety of morbid, and other, causes excited in so many differ- 
ent individuals, it is credible, that putrefaction, which is but 
a natural separation of organised matters, previously held 
together only by animal or vegetable life, should be capable of 
generating a new contagion ? Such matters spontaneously de- 
composing, and returning to their natural inorganic and 
harmless combinations, necessarily obey their respective che- 
mical attractions ; and the products resulting from this sort of 
obedience are as certain and constant as the formation of Sea- 
salt, by combining soda with muriatic acid. There is no 
chance, therefore, nor even possibility, of thus generating any 
thing so wonderful, and so immutable, as contagion, which, 
resembling animals and vegetables in the faculty of propaga- 
ting itself, must, like them, have been the original work of 
our common Creator, and must have been continued in exist- 
ence by the energies of a living principle, exerted successively 
in the different bodies, through which it has been transmitted 
from one generation to another. As well might we revive the 
for-ever exploded doctrine of equivocal generation, and be- 
lieve, as formerly, that insects, reptiles, &c. are the offsprings 
of mere corruption, as to believe that a substance so analo- 
gous to them, in that most mysterious and essential function 
of self-propagation, could originate from that cause, or form 
any operation of chemical agencies alone. 

As this reasoning, however, may not of itself produce gene- 
ral conviction, especially on strongly prejudiced minds, let us 
recur to matters of fact, and let these decide whether, in re- 
ality, any, and more especially a febrile, contagion has been 
produced by putrefaction. In former ages, when ignorance 
and credulity, which always accompany each other, were pre- 
valent, many surprising aad alarming stories were reported, 
and believed, of widely-spreading diseases produced by this 



93 

cause, and more especially by the putrefaction of animal sub- 
stances. Fortunately, the truth, or falsehood, of such reports 
may be easily ascertained by facts within our own knowledge ; 
for, as the same causes, cseteris paribus, must always produce 
similar effects, we have a right to expect that, if putrefying 
carcasses, fish, &c. were ever able to generate contagious, or 
other, fevers, they should still be able to do it, especially 
when collected in the largest masses, and when the impres- 
sions, to be made by their effluvia, are assisted by the most 
favourable circumstances. 

Many writers of celebrity, and among them the great Lord 
Bacon, have thought that no effluvia were so infectious, and 
pernicious to mankind, as those which issue from putrefying 
human bodies; and, although a century and a half has elapsed 
since Diemerbroeck* attempted to convince physicians that, 
at least, such effluvia could not produce the Plague, yet the 
old opinion has kept its ground ; and it is still believed, that, 
in their milder state, they may cause putrid fevers, and in 
their more concentrated state, a true pestilence. There are 
facts, however, on a large scale, which completely decide 
this question: — two of these deserve particular notice. — The. 
first relates to the exhumations made in the church-yard of 
St. Eloi 9 at Dunkirk, in the year 1783 ; and the other to 
those made three years afterwards, in the church-yard of 
the Saints Innocens, at Paris. As the undertakings and 
results were similar in both instances, I shall, to avoid re- 
petition, here describe only the latter, which I have pre- 
ferred, because the corpses here taken up were much more 
numerous than at Dunkirk, and probably constituted the 
greatest mass of putrefying animal matter, of which we 
have any accurate information. The church-yard of the 
Saints Innocens, at Paris, situated in one of the most po- 
pulous quarters of the city, had been made the depository 
of so many bodies, that, although its area enclosed more 

* Tractatus de Peste, Lib. I, Cap. viii. p. 41. 



94 

than 1700 square toises, or near two acres, yet the soil 
had been raised by them eight or ten feet higher than the 
level of the adjoining streets; and upon the most mode- 
rate calculation, considerably more than six hundred thousand 
bodies had been buried in it, during the last six centuries ; 
previous to which date, it was already a very ancient burial 
ground.* Numerous complaints having been made concern- 
ing the offensive smells, which arose from this spot, and some- 
times penetrated into the adjoining houses,! an{ l the public 
mind being greatly alarmed, it wafs at last determined to 
forbid all future burials there, and to remove so much of the 
superstratum as would reduce the surface to the level of the 
streets. This work was undertaken in 1786, under the super- 
intendance of M. Thouret, a physician of eminence in Paris, 
and in two years he accomplished the removal of that super- 
stratum, almost the whole of which was impregnated, or in- 
fected, as M. Thouret styles it, with the remains of carcas 
and of quantities of filth and ordure, thrown upon it from 
the adjoining houses. 



* In less than 30 years, more than 90,000 corpses had been deposited here by tht 
last grave-digger. The poor inhabitants were buried in coffins made of very thin deal 
boards, and were regularly stowed as closely as possible, upon and beside each other, 
in large pits about thirty feet deep, and capable of receiving each from twelve to fifteen 
hundred coffins. These pits were gradually filled with coffins, and then covered over 
with earth about one foot in depth, and the bodies left to putrefy. But as the same 
space was commonly wanted in fifteen or twenty years for other bodies, this mass of 
animal conniption was then dug up, and a like number of rrcent corpses deposited in 
the same pit ; and this operation was successively repeated through nearly the whole 
extent of the church-vard, from generation to generation, until the earth itself had 
been so completely supersaturated with human putrefaction, as to have no longer any 
action, or decomposing influence, upon bodies buried therein. 

f According to a Memoire on this subject, read at the Royal \cademy of Sciences, 
by M. Cadet de Vaux, in the year 1781, " Le mephitisme qui s'etoit degage d'une des 
fosses voisines du cimetiere, avoit infecte toutes les caves : on comparoit aux poitont 
les plus subtils, a ceux, dont les Sauvages irapregnent leur fleches meurtrieres, la terri- 
ble activite de cette emanation. Les murs baignes de Thum dite dont elle Irs 
troit, pouvoit communiquer, disoit on, par le seul attouchem • nt. Its acridens les ptas 

redoubtable*.* 1 See ■ Memoirs de la Sr^iete Royale de Medecine," torn. viiT. 

p. 21-2 ; also Annales de Chimie, torn. v. p. 158. 



95 

" The exhumations," says this gentleman, (in the narrative 
of them, which he published in the Journal de Physique, for 
1791, page 253) " were principally executed during the Win- 
ter, but a considerable part of them was also carried on 
during the greatest heats of Summer. They were begun with 
every possible care, and with every known precaution ; but 
they were afterwards continued, almost for the whole period 
of the operations, without employing, it may be said, any 
precaution whatever; yet no danger manifested itself in the 
whole course of our labours, — no accident occurred to disturb 
the public tranquillity." * This account is authentic, — and 
was read before the Royal Academy of Sciences at Paris. It 
is moreover confirmed by the report of M. Fourcroy, who 
was joined in this commission with M. Thouret for certain 
chemical objects, which report, was also read at the Academy, 
and is printed in the sixth volume of the Annales de Chimie. 
If this result from taking up nearly twenty thousand bodies, 
in different stages of putrefaction, be insufficient alone for my 
purpose, there is another almost equally conclusive in its na- 
ture and extent. 

It is well known that M. Berthe, Professor in the School 
of Medicine, at Montpellier, and two of his colleagues in that 
University, were sent, by the government of France, into 
Spain, to examine, and report upon, the nature of the Yellow 
Fever, which had proved so fatal in several towns of Anda- 
lusia, in 1800. M. Berthe has published the report of the 

• It does not appear, after the fullest inquiry, that any febrile disorder was ever 
produced by this immense mass of corruption, during the removals made in 1786, &c. 
or while it was suffered to remain as a burying ground. The grave diggers were, in- 
deed, sometimes thrown down suddenly, and, for a time, deprived of sense and motion, 
(as in what is termed Jlsphyxia,) by the concentrated vapours which escaped, upon 
accidentally breaking open, by their spades, the abdominal viscera of bodies, in an early 
stage of putrefaction. These vapours also, in a more diffused state, are said to have 
sometimes produced nausea, loss of appetite, and, in a course of years, paleness of* 
countenance, debility, tremors, &c. But fever of any kind, and much less contagious 
fever, does not appear to have been noticed, as resulting from the offensive, or putrid 
matters of this church yard, either to the grave diggers, or to the neighbouring inhabi- 
tants.— -See Annales de Chimie, torn. v. p. 154, &c. 



96 



commission, of which he was a memher, and in it has men- 
tioned that, being at Seville only a few months after the 
epidemic had ceased, he frequently visited the burying places 
just without the city, in which the victims of the fever had 
been interred ; that, in these excursions, he was accompanied 
by the French Consul at that city, and had occasion to con- 
verse much with the guards stationed at these places, and 
with the grave-diggers still employed in them : and he states, 
that, besides these, many thousands of the inhabitants of Se- 
ville also came thither, some from curiosity, and others in 
processions, to testify their sorrow and respect for their de- 
parted friends. In one of these grounds, south-westward of 
the city, ten thousand bodies had been buried ; in two others 
seven or eight thousand ; and in that of Triana about four 
thousand. 

"The heats of the Spring/' says M. Bcrthe, (which, I need 
not observe, are considerable at Seville) " were, at this time, 
beginning to be felt, and the ground of these burial pi 
being clayey, was already cracked into wide and deep cre- 
vices, through which a foetid odour was exhaled, the result of 
the decomposition which was going on among these heaps o\' 
bodies/'* 

Filled with alarm at the calamities which might be pro- 
duced by such masses of putrefaction, M. Berthe. and his 
colleagues, represented these supposed dangers to the Spanish 
government; and then went to Cadiz, where they found the 
churches more or less filled with putrid emanations from the 
same cause : but as they did not discover that these supposed 
fomites of infection were productive of any mischief, their 
fears concerning them seem at length to have subsided com- 
pletely ; for, in their reply to the President and Members of 
the Board of Health, who had requested a statement of their 
opinions, they expressly declare their belief, that M if the 
Yellow Fever could be produced by the effluvia arising from 

* See page 28 of " Precis Historique de la Makdie qui a 
en 1800, par I. N. Berthe, Professour de I'ecole de Mriecjuc de Moutpelliei . 



97 

putrefying bodies, it was evident that such a misfortune must 
already have taken place, through the imperfect manner in 
which the tombs and vaults, pointed out by them, had been 
closed, — a defect which they had observed even in the church- 
es that they were most frequented. 9 '^ Thus it appears that 
the putrid emanations from the bodies of many thousand per- 
sons, who had recently'died of the Yellow Fever, did not, and 
therefore could not, produce that disorder. 

To the preceding facts I may add another, which is related 
by a man whose veracity is as little to be questioned, as his 
exalted philanthropy, — I mean John Howard, in his work on 
Lazarettos, page 25. 

" The governor, at the French Hospital at Smyrna, told 
me, (says Mr. Howard) that, in the last dreadful plague there, 
his house was rendered almost intolerable by an offensive 
scent, especially if he opened any of those windows which 
looked toward the great burying ground, where numbers were 
left, every day, unburied ; but that it had no effect on the 
health of himself or his family. An opulent merchant, in this 
city, adds he, likewise told me that he and his family had felt 
the same inconvenience without any bad consequences." 

If the exhalations from piles of bodies destroyed by the 
plague itself, and corrupting in the open air, were thus inca- 
pable of generating the contagion either of fever or of plague, 
even during the prevalence of a pestilential constitution of the 
atmosphere, (if any state of the atmosphere ever deserved that 
title) it may, I think, be safely affirmed, that there are no cir- 
cumstances under which putrid animal matter can be supposed 
ever to produce febrile contagion. 

I have now before me a great number of similar facts, well 
authenticated ; but those which I have just stated will, proba- 
bly, suffice to convince most of my readers, that if putrefying 
animal matters are not completely harmless, they are, at 
least, innocent of the charge of producing contagious fevers; 

* Sec page 331 of M. Berthe's work, 
13 



98 

and, therefore, I shall content myself with referring those who 
may desire further evidence on this point, to Appendix, No. 2, 
where they will, I believe, find rather a redundancy, than a 
deficiency, of such proofs. 

Whatever variety of sentiment may have been entertained 
with respect to the supposed generation of infection by filth, 
or by putrefying bodies, it appears to* have long been an uni- 
versal opinion, at least among those who have admitted the 
existence of any infectious fevers, that, to use the words of 
Dr. Cullen, (first lines of the Practice of Physic, Sec. lxxxi.) 
66 the effluvia constantly arising from the human body, if long 
retained in the same place, w ithout being diffused in the at- 
mosphere, acquire a singular virulence ; and in that state, 
being applied to the bodies of men, they become the cause of 
a fever, which is highly contagious." 

This opinion is become so familiar, that few T persons hesitate 
to adopt it, however difficult it be to comprehend by w hat 
means these effluvia can acquire such contagious properties.* 

* Dr. Chisholm, in his Essay on the Malignant Pestilential Fever, kc. page 281, of 
vol. i. includes, among the causes of that disease, " the product of animal substances 
of evety description, deprived of lift-, and in a state of pu re facti on, which, exhaling 
azote and oxygene chemically combined, and diffusing through the atmosphere to a 
certain extent the basis of pestilential infection, are equally capable of producing 
contagious and pestilential diseases." The same author bus again recently delivered 
this doctrine in several parts of his letter to Or. Haygarth, (8vo. IS09,) partk 
at page 133, where he mentions, as a "most important fact in medical pi 
that the vapour, or exhalation, arising from animal matter, accumulated in a | 
state, and rendered stationary by the neglect of ventilation, is universally the cause ot 
the fever of infection,— the Top/.us, which annually diminishes the population of these 
cities," Sec. " The same causes, (he adds,) probably gave origin to the Pt'agi/e." 
Very soon after this, however, (i. e. in October last,) Or Chisholm, with laudable 
candour, thought proper, in a great degree, to retract this doctri' i 

" That the effluvia from dead animal bodies, passing through the natural i 
of putrefaction, and unrestrainedly diffused through the atmosphere, is injurious to 
living animal bodies exposed to their action, no more than inasmuch as their fcetor 
is offensive to the olfactory nerves; that, when confined to a very limited space, and 
their principles, instead of entering into new combinations, are concentered, a d in 
that state applied to, or received i;>to, the bodies of living animals, these effluvia 
may act as a poison, produe ng in the living animal frame fever perhaps, but m- 
vpiiimunicable, or incapable of propagation by contagion ; or instant death by a snd» 



99 

We can all understand that if a persan under an infectious 
disorder be confined in an ill ventilated room, the infectious 
effluvia, when they are of a powerful nature, will, with the 
other emanations from his body, be gradually accumulated, 
and the atmosphere of that room may thus, at length, become 
loaded with infection ; but, that the emanations from a person 
who was not ill of an infectious disease, should ever undergo 
so remarkable a change in their nature, as from being innoxi- 
ous, to acquire not only the power of producing a disease, but 
a contagious disease, capable of regenerating itself in other 
persons, seems to me incredible. 

I have already remarked, particularly in regard to the 
Small Pox, that the human body has no power even to alter, 
in the slightest degree, a contagion already existing therein ; 
and that it must be infinitely more difficult for it to generate 
one entirely new. If it were otherwise, with what certainty 
would it not be effected in a variety of places, which are en* 
tirely exempted from it. Take, for instance, those in which 
the natives of Kamstchatka dwell constantly during seven 
months of the year, and which are called yourts ; these are 
sunk seven or eight feet below the surface of the ground, and 
are covered with a thatched roof, in the form of a truncated 
cone, open at the top ; they consist of one small apartment, 
which usually contains six families with their utensils, and 
stock of provisions for the winter, the chief part of which is 
dried fish almost putrefied. 

If the combination of personal nastiness, with the most 

den exhaustion of the living principle." — See. his paper in the Edinburgh Medical 
and Suigical Journal, Oct. 1810, page 3S9. 

But though Dr. Chisholm has sb far returned towards what 1 believe to be the 
path of truth, he still adheres to the commonly received opinion of the generation of 
contagious fever, by crowding; and deficient ventilation. (( The cause, in fact, 
(says he,) of Typhus* is, I believe, an undefined change in the atmospheric air, 
brought about by its confinement in a very limited space, and incapacity, in a great 
degree, of renewal, and the respiration of an effluvia, (effluvium) emanating from. 
the persons inhabiting the wretched close dwellings in which the fever is found." — • 
See Note to page 391, of the Edinburgh Medical and Physical Journalj Oct. 1310. 



100 

putrid smells and foul air, were capable of creating the con- 
tagion of fever, every yourt would necessarily be a fomes of 
infection. " Here they eat, drink, - and sleep, crowded pro- 
miscuously together : and satisfy all the calls of nature with- 
out modesty or restraint, and never complain of the noxious 
air that prevails in these habitations.* Yet, instead of being 
generally attacked by contagious fevers every winter, they 
seem to enjoy as good health during this season of confine- 
ment as any other people : and fevers are not even mentioned 
in the list of diseases, which iliat respectable traveller, M. 
Lessep, either observed, or heard of. as existing among them. 

The people of the island of Oonalaska, also, u inhabit jourts, 
or subterraneous dwellings, each common to many families, 
in which they live in horrible filthhiess :" — ( Pennant's Arctic. 
Zoology, vol. i. page cliv.) and the Samoiedes live in sub- 
terraneous dwellings, equally filthy, for almost nine months 
iu the year, vs ho yet are reported by travellers to be strong, 
active, and healthy. In addition to all this filth, crowding, 
and want of ventilation, the food of these people may be con- 
sidered as little better than putrefaction itself. Mr. Pennant, 
describing that of the natives of Kamstchatka, says, M their 
ambrosial repast is the Huigal. or fish flung into a pit until 
it is quite rotten, when it is served up in a state of carrion, 
and with a stench that is insupportable to e\m nose but that 
of a Kamschatkan." But these people, notwithstanding, are 
seldom attacked by any other disease than scurry, for which 
they seem to possess a remedy in the Allium Ursinum, or 
Wild Garlic, and in the Pinus Cental 

The Greenlanders and Esquimaux appear, by the account* 
of those celebrated navigators, Davis, Frobisbcr. Baffin, 
Henry Ellis, fcc. as well as of Bishop Egede and Grants, to 
live, during the greater part of the year, in very close, ill. 

* See Lessep 's Travels, page -230, &c. also Pennant's Arctic Zoology, \ 
page exxxii. also Voyage to the Pacific Ocean, &c. vol iii 

t Arctic Zoology, vol. i. page cxix. also Lessep 's Travels, page 90. 



101 

ventilated, and crowded habitations, (without chimneys) 
which, notwithstanding the great severity of the cold, they 
keep extremely warm by their numbers and breath, assisted 
by a single burning lamp in each, and by excluding fresh air 
so completely, that any other people would think themselves 
in danger of being suffocated by the offensive vapours con- 
tinually exhaling from the lungs and bodies of the inhabitants, 
and which involve them as a thick fog ; and yet fever of any 
kind is a rare disease among these people, though, like those 
of Kamstchatka, &c. they are much disposed to scurvy. 

Dr. Matthew Guthrie, Physician at St. Petersburgh, in a 
letter to Dr. Priestley, on the Antiseptic Regimen of the 
Natives of Russia, inserted in the sixty-eighth volume of the 
Philosophical Transactions, mentions, at page 623, that " the 
Russian boor lives in a wooden house," " caulked with moss, 
so as to be snug and close. It is furnished with an oven, 
which answers the triple purpose of heating the house, dress- 
ing the victuals, and supporting, on its flat top, the greasy 
mattrass on which he and his wife lie." 

" During the long severe winter season, the cold prevents 
them from airing this habitation, so that the air cannot be 
very pure, considering that four, five, or six people eat and 
sleep in one room, and undergo, during the night, a most 
stewing process from the heat and closeness of their situation, 
insomuch that they have the appearance of being dipped in 
water, and raise a steam and smell in the room, not offensive 
to themselves, but scarcely supportable to the person whom 
curiosity may lead thither." 

M Now, if it be considered that this human effluvium must 
adhere to every thing in the room, especially to the sheep- 
skins, or mattrass on which they sleep, the moss in the walls, 
&c. and that the apartment is never ventilated for six months 
at least ; at the same time that these people are living upon 
salt-fish," &c. " and the whole time without fresh vegetables," 
&c. " If it be a fact that they are, in spite of all these pre- 
disposing causes, strangers to putrid disease, it will sufficiently 



102 

justify my first assertion, that the regimen, nature has dictated 
to these people, is highly antiseptic." 

Dr. Guthrie had, in a preceding part of this letter, stated 
that, notwithstanding this mode of life, " the Russian boor 
enjoys a state of health that astonishes an inhabitant "of a 
country where the dreadful consequences are so well known 
of bad air within, excessive cold without, joined to a want ol* 
fresh vegetables for a length of time." 

Dr. Guthrie has stated these facts principally to shew the 
supposed beneficial effects of the Russian drink called Quass, 
&c. ; but I am entitled to avail myself of them for the purpose 
of demonstrating, that long confinement in close unventilated 
houses, without chimneys, in an atmosphere replete with human 
effluvia, and in very cold weather, when Typhus or Contagi- 
ous Fever is commonly most prevalent, does not produce that 
disease, it being, as will hereafter appear, unknown in that 
part of the world. 

Dr. Charles de Mertens, an eminent physician who had 
resided many years in Russia, writes, in a letter from Vi- 
enna, dated January 14, 1778, and printed in the same volume 
of the Philosophical Transactions, page 661, kc. that " the 
common people (at Moscow J live in small wooden houses, 
generally very low, in which they crowd together both night 
and day, during three parts of the year, on account of the 
great cold. There is little air in the room, the windows of 
which are very small. Here they stew together in humidity 
and nastiness; for except the bath, which they use once a 
w^eek, they are extremely nasty." These people, he observes^ 
enjoyed, notwithstanding, a much better state of health than 
the higher classes of society at Moscow, w ho w ere frequently 
attacked severely by scurvy.* 

* From the description given by Dr. Orneus, (Politise Petropolkanie Medicus,) 
the habitations of the Russian and Polish peasants seem, at least, to equal those of 
the poor of any other country, in accumulated filth and foul human effluvia. Hi? 
words are as follow, viz. — 

« Et?cui ignota es pauperculorum vivendi ratio ? Degunt cumulatim in doraun- 



103 

Having stated these facts in regard to the supposed effects 
of crowding human beings in small unventilated habitations, 
in northern countries, let us see what effects result from simi- 
lar causes in the warmer regions. And here the African 
slave ships most obviously present themselves for examina- 
tion. Until within a few years these vessels notoriously con- 
veyed human beings across the Atlantic in a state of closer 
compression, and in an atmosphere more offensively impreg- 
nated with human exhalations, excretions, and excrement, 
than could probably be found in any other place of confine- 
ment. " The poor wretches (says Dr. Lind, in his treatise 
on the jail distemper) are crowded together below the deck, 
as close as they possibly can lie, with only a small separation 
between the men and women ; every night they are shut up 
under close hatches, in a sultry climate, barred down with 
iron to prevent an insurrection ;" " and though some have 
been suffocated by the close confinement, or foul air, though 
they are subject to the flux, and suffer from a change of cli- 
mate, yet an infection is scarce known among them ; or if an 
accidental Fever, occurring from the change of climate, should 
become infectious, it is generally much more mild than in the 
opposite situation," — i. e. that of ragged felons under trans- 
portation. It will be here observed, that Dr. Lind, influenced 
as he was by the commonly-received opinions, mentions an 
infection (meaning of Fever) as being " scarce known" in 
the slave ships, instead of asserting, as he might have don§ 

cul'is depressis, angustis, bumidiusculis ; esculenta & potulenta sua, partim jam cor- 
vupta & fermentantia in iisdem vaporibus empyreumaticis obnubilati, apparant ; 
quisquilias raro everrunt ; illuvies varias, negUgentius quaquaversum profundunt; 
at alias immundities ex infantibus & propriis excretionibus provenientes, taceara. 
Mepbitidi hinc productse assueti, de renovando aere vis cogitant- Uti Jassise, sic 
etiam in Polonia, ubique fere inter Judseos pauperiores, sordide omnino & arete, 
uti notum est, viventes, prima pestis quasi incubatio fiebat. Medici, qui Moscuae, 
in officinam pannorum, ad examinandum infectos, repetitis vicibus mittebantur, de 
fcetore in babitatiunculis operariorum, cui vix per aliquot nunuta perferendo pares 
essent, conquerebantur."--Vide " Gustavi Orrjei, M. D Descriptio Pestis qua: anno 
MOCCLXX in Jassia, & MDCCLXXI in Moscua grassata est- Petropoli, 
1784;"— Page 51. 



104 



• 



with truth, that it is never known : for after very extensive 
inquiries, I am fully convinced that Fever of any kind rarely 
occurs on board these vessels, and contagious Fever never; 
though great mortality has frequently happened from other 
diseases, and more especially from Dysentery.* Dr. Trotter, 
who was formerly surgeon to a slave ship, after noticing 
what I have just stated from Dr. Lind, adds, " The confine- 
ment of so many wretched creatures in a small space, deserv- 
edly attracted the animadversion of a physician investigating 
the sources and progress of contagion. But Contagions Fe- 
vers we find are not their diseases." See Medicina Nautica, 
vol. i. p. 184.f 

I could readily accumulate proofs in confirmation of the 
preceding statement, concerning slave ships ; but the truth in 
regard to it is now so generally known and acknowledged, 
that they must be unnecessary ; and there certainly is nothing 
in the constitutions of Negroes, which exempts them fi^m 
Typhus or Contagious Fever; on the contrary, they have 
been found as susceptible of it as Whites, and considerable 
numbers of them, who were sent from this country, and from 
Nova Scotia, to the new colony of Sierra Leone, died of it 
on their passage thither, as will be more fully related in 
another place. 

An instance of the crowding of Europeans on ship board, 
which approaches very nearly to that of Negroes in slave 
ships, may be found in the " Narrative of the deportation to 
Cayenne," of J. J. Job Aime, and one hundred and ninety- 
two other persons, on board the Decade frigate, in conse- 



* See Lind on preserving the health of Seamen, page 317, 318, Second edition. 
f Dr. Garden, in a letter to the Rev. Stephen Hales, D. D dated Charleston », 
South Carolina, March 24, 1756, after mentioning the Guinea slave ships arriving 
there, adds, " I have often gone to visit those vessels on their first arrival, in order 
to make a report of their state of health to the governor and council ; but 1 ne- 
ver yet was on board one, that did not smell most offensive ami noisome: what 
from filth, putrid air, putrid dysenteries, (which is their common disorder) it is a 
wonder that any escape with life." See Dr. Hale's Treatise on Ventilators, second 
part, page 95 



105 



quence of the revolution (in France) of the 18th Fructidou, 
(Sept. 4th,) 1797, written by himself, and printed for J. 
Wright, Piccadilly, 1800. In this narrative the writer 
says, (page 78) " we were placed in the between-decks, be- 
fore the fore-mast and main-mast, occupying nearly one- 
fourth of the superficies of the vessel, having about four feet 
and a half in height, and receiving no light but by the scut- 
tles ; that is to say, by two openings of three feet square." — 
" Partitions had been made in this part of the between-decks," 
&c. "In this place, the door of which was locked, were 
crowded and squeezed together 193 individuals, mostly aged 
and infirm. We lay in two rows one over the other, forming 
as it were, two stories, in hammocks of coarse cloth, and ex- 
tremely narrow." " Those above could not raise their heads 
without hitting those above ; neither could any of us make the 
smallest motion without disturbing his neighbours ; for we all 
touched each other, and, not having the least spare room, 
formed, as it were, but one mass." " And that nothing might 
be wanting to increase the horror of our situation, as we were 
not permitted to go out for fourteen hours together," (i. e. 
from 6, P. M. until 7 1 A. M.) " and sometimes more, tubs had 
been placed in the midst of us, where we might satisfy the in- 
dispensible wants of nature ; and to get to these sorry re- 
ceptacles, we were obliged to creep, on our bellies, beneath 
the hammocks. How insupportable then must have been the 
infection of such a close confined place, which was already 
poisoned by our own exhalations ! Indeed, the air, which 
passed from this hole, was so hot and foetid, that the centi- 
nels, placed at the hatchways as our guard, demanded that 
the time of their duty, at so dangerous a post, might be 
shortened." 

In addition to this morbid atmosphere, the exiles, most of 
whom had been " accustomed to the elegance of life," were 
condemned to subsist upon the coarsest, the most disgusting, 
half-putrefied food, in the taking of which, says Aime, " we 
resembled a flock of animals who eat their food out of one 

14 



106 

common trough," and were, besides, made " a subject of 
mirth," by " the officer who superintended the distribution of 
our meals," which were also too scanty to satisfy the cravings 
of hunger, — (page 82 to 85.) They were also condemned to 
endure the greatest and most offensive personal filth, swarm- 
ing with lice, &c. " If it be recollected, (says the author) 
that we were obliged to sleep in our clothes, and when it is 
known that several of us had not taken off our lesser gar- 
ments during the voyage, it may be easily conceived that it 
was not our linen alone, into which these horrible vermin had 
introduced themselves." — (Page 81.) " Our blood, it is 
true, was not shed, (says he,) but there was not one of us, 
who would not have a thousand times preferred a speedy 
death, to the miserable state in which we existed." — (Page 
85.) But though they were kept in this state during ninety- 
six days, and, to use the words of Aime, " there was every 
reason to expect, that one half of us would have been the 
victims of such inhuman treatment; nevertheless, astonish- 
ing as it must appear, under these circumstances, not one 
of us perished." — (Page 85.) They were, indeed, as might 
well be supposed, attacked by scurvy and other disorders, 
some of which are called fevers, though the latter appear 
to have been so slight, and of so short a continuance, as 
hardly to deserve that name ; but certainly nothing like 
contagious fever existed among them, or could have exist- 
ed in such circumstances without extensive mischief. Indeed 
there was only one person lost during the voyage, and he (a 
sailor) accidentally fell overboard. And yet here was every 
thing likely to generate febrile contagion, (if it could be ge- 
nerated by crowding, want of ventilation, filthy clothing, 
and unwholesome, corrupting food, together with anxiety and 
dejection of mind, &c.) to a much greater extent than in 
any gaol within Great Britain. 

In Dr. Lind's Essay on preserving the Health of Sea- 
men, page 195, I also find the following statement, viz. 

"During the month of October, (1759) the squadron 



107 

arrived from the West Indies, after the reduction of Guar 
daloupc, so over-run with the scurvy, that, when in the 
channel, ten or a dozen persons usually died of it every 
day. Out of three hundred and fifty scorbutic patients, 
who were sent ashore from those ships, there was not one who 
had a fever. This I mention, (says Dr. Lind,) for the sake 
of the following remark : The surgeon of the Panther" 
(of sixty-four guns) " told me, that forty of her men had died 
of the scurvy in their passage home ; and, during that time, 
there were usually ninety patients in the sick apartment. 
The place appropriated for the sick, was in the bay of the 
ship, (which Dr. Lind calls " the most damp and unwhole- 
some part of a ship," page 133) "and had no pipe from 
the ventilator, nor any scuttles cut through its sides, for the 
admission of the fresh air. A number of patients, thus 
closely crowded together, rendered the place so disagreea- 
ble and suffocating, that the sick were in a manner stifled 
or want of air. The surgeon, when visiting, could scarce- 
ly breathe in it, or remain for any length of time, without 
being obliged to have recourse often to the fresh air upon 
deck, and sometimes to spirit of hartshorn, or to a glass 
of wine, for his immediate relief. He observed, that both 
the virulence and mortality of the scurvy were heightened 
by the unventilatcd air of Jhe place, in which the sick, for 
several weeks, had been confined ; yet, out of above an hun- 
dred patients, sent to the hospital by this surgeon, not one 
was remarked to have any symptom of contagion generat- 
ed in that apartment." 

Another fact, which deserves mentioning, relates to the 
prisoners taken out of the memorable Spanish galeon, cap- 
tured, by Commodore Anson, in the Centurion, on the 20th 
of June, 1742, and is recorded at pages 492 to 496, loth 
edition, of the Account of the Commodore's Voyage round 
the World, published by Mr. Richard Walter, who had ac- 
companied him as his chaplain. 



108 

"The galeon had five hundred and fifty men at the begin- 
ning of the action," of whom " sixty-seven were killed, and 
eighty-four wounded." All the prisoners were " sent on 
board the Centurion before night, except such as were thought 
the most proper to be retained to assist in navigating the ga- 
leon." The prisoners were " placed, all but the officers and 
the wounded, in the hold, where to give them as much air as 
possible, two hatchways were left open." " The sufferings of 
the poor prisoners, though impossible to be alleviated, were 
much to be commiserated ; for the weather was extremely hot, 
the stench of the hold loathsome beyond all conception, and 
their allowance of water but just sufficient to keep them alive. 
All this considered, it was wonderful that not a man of them 
died during their long confinement," (from June the 20th to 
July the 28th,) " except three of the wounded, who expired 
the same night they were taken." 

An additional proof of the like import may be derived from 
the dreadful catastrophe, in the black-hole, at Calcutta, on 
the 20th of June, 1756, in which, out of one hundred and 
forty -six persons, one hundred and twenty-three perished by 
suffocation. And a further reason with me for noticing it is, 
-to correct the misrepresentations thereof, which I have heard 
and seen ; for it has been asserted, that the twenty-three sur- 
vivors were afterwards seized with Typhus Fever, as, indeed, 
they ought to have been, if crowding, with an accumulation of 
human efiluvia, and want of ventilation, could produce it 
But whoever will read the narrative of this occurrence, given 
by Mr. Holwell, the chief officer of the British factory at Cal- 
cutta, (which none of the medical writers I allude to seem to 
have perused, or, at least, not with due attention.) will, I am 
sure, be convinced, from all the subsequent events, that not- 
one of the survivors in question was attacked by any disease 
which could, with propriety, be called a fever. It was impos- 
sible indeed for men, who had undergone such extraordinary 
sufferings, and had preserved their existence with so much 
difficulty, not to feel exhausted and indisposed, when 



109 

were released from their dungeon the next morning ; and it 
seems that, within forty-eight hours, every one had a consi- 
derable eruption of boils over his body, which was probably 
caused by the excessively profuse perspiration, which each of 
them had undergone, and is not a rare consequence of very 
copious sweating. But, as I shall demonstrate in the Appen- 
dix, No. 3, a fever did not ensue in a single individual among 
them ; and, therefore, no febrile contagion was generated, 
even in an atmosphere rendered pernicious to life, and not 
only loaded with effluvia perspired from the living body, but 
also with the most offensive smells from those who expired in 
the course of the night, and whose bodies had fallen into rapid 
putrefaction, as soon as life was extinguished. 

The Lord Chancellor Bacon seems to have been strongly 
impressed with a belief of the existence of contagion in pri- 
sons, and of its being, at least, greatly augmented, if not ge- 
nerated, by filth and deficient ventilation. " The most perni- 
cious infection, (says he,) next to the Plague, is the smell of 
the Jail, where prisoners have been long, close, and nastily 
kept ; whereof we have had, in our time, experience twice or 
thrice, when both the judges that sat upon the Jail, and num- 
bers of those who attended the business, or were present, sick- 
ened upon it, and died."^ — (In Sylva Sylvarum, Cent. 10, 
Num. 914.) 

* Mr. Anthony Wood, iu his " History and Antiquities of the University of Ox- 
ford," published by John Gutch, M. /V. Oxford, 179G, after mentioning the J31aek 
Assize in that city as one of the "-Mortalities," which Lord Bacon must have con- 
templated in the passage just quoted, adds, " where the other happened I am not 
certain; however, that the like was at Cambridge, at the Vssize kept in the Castle 
there, in the time of Lent, 13th of Henry VIII. Ann. Dom. 1521-2, is evident; for 
the justices there, and all the gentlemen, bailives, and all resorting thither, took such 
an infection, that many of them died ; and almost all that were present fell des. 
perately sick, and narrowly escaped with their lives." — Vol. ii. page 188, &c t 
This seems to have been the earliest instance of what, perhaps, may be considered 
as jail infection, communicated in a Court of Justice, of which any information has 
been transmitted to us ; but Lord Bacon could not, with propriety, have men- 
tioned it, as occurring in his time; it having happened forty years before his birth* 



110 

One of the instances here alluded to, doubtless, was that of 
the memorable Black Assize at Oxford, in the month of July, 
1577, which I shall more particularly notice in the Appendix 
No. 4. The other instance seems to have been that mentioned 
by Holinshed, as occurring at Exeter, during the Assizes 
there, in March, 1586, of which a further account will be 
found in the same Appendix. 

From that time I can discover no instance of any remarka- 
ble mortality or sickness, supposed to have been produced by 
Jail infection, until the year 1730, (an interval of one hundred 
and fifty-three years,) when, at the Lent Assizes, some pri- 
soners, who had been removed from llchester Jail, to take 
their trials at Taunton, were believed to have infected a part 
of the Court, and produced a contagious disease, of which the 
Chief Baron Pengally, with some of his officers and servants, 
and Sir James Shepard, Knight, and Serjeant at Law, died 
afterwards, at Blandford, in Dorsetshire. John Pigot, Esq. 
High Sheriff of Somersetshire, also died, as was supposed, of 
the same disease, which spread considerably at Taunton, and 
proved fatal to several hundreds. — (See Gentleman's Maga- 
zine, for May, 1750.) 

Twelve years after, viz. in April, 1742, according to Dr. 
Huxham, (de Aere, &c. vol. ii. p. 82,) a fever, which he calls 
putrid, contagious, and highly pestilential, (<• febris putrida, 
contagiosa ac pestifera valde,") appeared at, and in the neigh- 
bourhood of Launceston, occasioning great mortality there. 
This fever, he adds, was generated in the prisons, and widely 
disseminated by means of the County Assize, — (•'*' genita hsec 
in carceribus febris et per comitia provincialia disseminata 
longe lateque.")* 



* At page S3, Dr. Huxham makes this addition, viz. — " Perfreqaens est utique 
generatio febris pestilentis in angustis immundisque carceribus ; etiam ipse aer conclu- 
sus in fodinis, speluncis, puteis, tandem evadit exitialis admodum idque longe citius, 
si accedunt quoque plurima animalium effluvia, quse et ipsa porro magis magisque in 
hoi-as violenta fiunt, brevique pestifera rnaxime." — (Here he refers to Lancisi de 
repentinis mortibus, L. i. C. 6) " Atmosphsera stagnans, frequentia hominum polluta, 
mox valde rancet & ad respirationem inepta est prorsus ; imo aquae dulcis balneum 



Ill 

The next remarkable occurrence of this sort happened at 
the Sessions of the Old Bailey, in the spring of 1750, which 
proved fatal to the Lord Mayor, and two of the Judges, with 
several eminent and other persons, who, as was asserted, and 
is now generally believed, were infected by the contagion of 
Jail Fever brought into the Court from Newgate. With how 
little reason or truth this assertion was made, I shall endea- 
vour, by a minute examination of facts, to ascertain, and de- 
monstrate, in the Appendix, No. 4. And this task I have the 
more readily undertaken, by reason of the very important 
conclusions respecting febrile contagion, which have been, as 
I think, erroneously deduced from the melancholy events in 
question. 

It was in consequence of, and immediately after, this me- 
morable transaction, (viz. in May, 1750,) that Sir John 
Pringle published his " Observations on the nature and cure 
of Hospital and Jail Fevers," from pages four and five of 
which the following extract is made, viz. 

" The hospitals of an army, when crowded with sick, or 
when the distempers are of a putrid kind, or at any time when 
the air is confined, especially in hot weather, produce a fever 
of a malignant nature, always accounted fatal. I have ob- 
served the same sort of fever to take its rise in crowded bar- 
racks, and in transport ships, when filled beyond a due num- 
ber, and detained long by contrary winds, or when the men 
were kept at sea, under close hatches, in stormy weather." 

'? The cause seems plainly to arise from a corruption of the 
air, pent up, and deprived of its elastic parts by the respira- 
tion of a multitude; or more, particularly vitiated with the 
perspirable matter, which, as it is the most volatile part of the 
humours, it is also the most putrescent." 

As soon as I became acquainted with this fever in the hos- 
pitals abroad, I suspected it to be the same with what is called 

sorde cutanea fcedatum putrescit atqne putct brevissirae. Nee mirura est hoc utique, 
quandoquidem a quolibet aduito homine unciae 40 feri rancidi vaporis quotidie 
<?xhalant." 



112 



here the Jail Distemper, which I had never seen ; and was 
confirmed in my opinion, by having an opportunity of com- 
paring them, which was furnished by the following accident." 

Here the author relates the means by which two hundred 
men, of Brigadier Houghton's regiment, were, in 1746, at- 
tacked by a " fever, which came directly by contagion from 
the true Jail Distemper," communicated in a manner which he 
describes : and these men, he adds, " being under my care, I 
had the best opportunity of examining the distemper, which I 
found differed in nothing from the usual Hospital Fever, in 
either symptoms, violence, or cure." And on this foundation 
he proceeded to " consider the two diseases as one" and to 
describe them accordingly ; having, as he observes, " met 
with no author who has treated them in so clear and full a 
manner, as to enable a physician either to know, or cure 
them." — Page 7. 

When this was written, external putrefaction was believed 
to produce highly morbid and malignant effects upon, and 
within, the living human body : and both Dr. Huxham and 
Sir John Pringle, prepossessed by this belief, were thereby, 
probably, induced to promulgate their doctrines and opinions 
on this subject with less consideration, and more confidence, 
than men of their superior talents and understanding, would 
otherwise have done. Indeed, Sir John Pringle (and proba- 
bly Dr. Huxham) was ignorant of an important fact, which, 
if known, might have altered his opinion on this subject ; for 
he was manifestly convinced, that warm, or hot weather, 
would promote the activity and force of Jail contagion, (as, 
in truth, it ought to do, were, that contagion generated by 
filth, putrefaction, and deficient ventilation ;) and in the pub- 
lication just mentioned, he expresses his belief, that the fever, 
supposed to have been recently produced by infection froin 
Newgate, would " be, in a great measure, confined to those 
who were present at the trial, especially if the weather con- 
tinued moderately cool;" not suspecting, what is now ascer- 
tained,, that the contagion of Typhus, or Jail Fever, is always 



113 

rendered most virulent and morbific by severe frost,* which, 
by increasing* the density and purity of the air, renders ven- 
tilation least necessary, and completely arrests the progress 
and influence of putrefaction and of its products; while, 
on the contrary, this contagion is soon enfeebled, dissipat- 
ed, and destroyed by hot weather, in which putrefaction 
proceeds most rapidly, and crowding with deficient venti- 
lation is most hurtful. 

The opinions, however, of these celebrated physicians are 
now generally prevalent in this country, and more especial- 
ly in regard to prisons, which are considered as eminent- 
ly the parent as well as the fomes of the contagion of Typhus 
Fever. That this fever often exists in them cannot be de- 
nied,- but this circumstance can afford no evidence of its 
having been generated therein, any more than the multi- 
plication of vermin in such places could demonstrate the 
spontaneous generation of these, and other insects, by the 
nastiness which favours the deposition, and hatching of their 
eggs. It must, indeed, be impossible to adduce any suffi- 
cient affirmatiT?$s proof on this subject ; for, as the contagion 
of Jail Fever, though commonly inactive during the hotter 
part of the summer, always exists in this country ; and, as 
it frequently remains dormant in the human body several 
months after being received therein, the breaking out of this 
fever in a prison can never afford any evidence of its hav- 
ing been generated, where it first appears. For, even if 
the person first attacked should have been so long imprisoned, 
as to make it incredible that he was infected previously to 
his imprisonment, there must always have been so many 
ways and means, by which the contagion might have been 
introduced from without, (e. g. by infected persons, gar- 

* The benevolent John Howard, in his work on Prisons, (page 467,) observes, 
that " the Goal Distemper is always observed to reign more in our prisons du- 
ring winter than summer ; contrary, I presume, (addfc he,) to the nature of other 
putrid diseases." Similar, but stronger, testimonials will hereafter be adduced. 

15 



114 



ments, bedding, &c.) that its having been so introduced 
will always be much more probable than the spontaneous 
generation of contagion ; an operation, or process, of which 
we have no example, and which, if it really took place, 
would to me seem miraculous. 

I have already proved, that crowding, filth, and deficient 
ventilation, do not, in a variety of other situations, pro- 
duce any thing like contagious fever; and I might fairly 
conclude, therefore, that these causes would not be more 
efficacious or noxious in jails, than they are found to be in 
the places already mentioned. But least any persons should 
imagine* that there may be some circumstances in a prison 
peculiarly suited to the generation of what is called Jail 
Fever, I will, in regard to this particular, undertake what 
I have already performed in regard to the putrefaction of 
animals, &c. and instead of requiring affirmative proofs 
from those who assert the generation of febrile contagion 
by such causes, will take upon myself to refute these unsup- 
ported assertions by decisive negative evidence : and for this 
purpose I will resort to the observations aid testimony of 
Mr. Howard, than whom no man ever took more pains to 
ascertain the truth concerning prisons, or stated it with 
more exactness and candour ; and the result of all that he 
either heard or saw is, that the Jail Distemper is not known 
in the prisons abroad. 

In his work on Prisons, he informs us, (page 125,) that 
on conversing with Dr. Tissot, at Lausanne, the latter ex- 
pressed his surprise at our Jail Distemper ; said, " I should 
not find it in Switzerland;" and added, that "he had not 
heard of its being any where but in England." "I did 
not," continues Mr. Howard, (as the Doctor said,) " find 
the Jail Fever in Switzerland." 

In regard to the prisons at Venice, Mr. Howard says, 
(page 106,) of the s^ame work, "the chief prison is near 
the Doge's Palace, and it is one of the strongest I ever 
saw. — There were between three and four hundred priso- 



115 

ners, many of them confined in* loathsome and dark cells 
for life $ executions here being very rare. There was no 
fever or prevailing disorder in this close prison." 

At page 117 of the same work, Mr. Howard, describing 
the great prison of Naples, La Vicaria, says, " it contain 
ed, when I was there, according to the gaoler's account* 
nine hundred and eighty prisoners. In about eight large 
rooms, communicating with one another, there were five 
hundred and forty sickly objects, who had access to a court, 
surrounded by buildings so high as to prevent the circula- 
tion of air. In seven close offensive rooms, were thirty-one 
prisoners almost without clothes, on account of the great 
heat ; and in six dirty rooms, communicating with one 
another, were fifty women." Here he adds the following 
note, viz. " In visiting the prisons of Italy, I obserugg, that 
in general great attention was paid to the sick ; but I could 
not avoid remarking, that too little care was taken to pre- 
vent sickness. From the heat of the climate, one might 
imagine the Jail Fever would be very likely to prevail ; but 
I did not find it in any of the prisons." 

Sir John Pringle, in a discourse delivered by him to the 
Royal Society, as their president, the 30th of November, 1776, 
says, " the late Dr. Mounsey, (F. R. S.) who had lived long 
in Russia, and been Archiater under two successive sovereigns, 
acquainted me that, happening to be at Moscow, when he 
perused my observations on the Jail and Hospital Fever, then 
lately published, (1750,) he had been induced to compare what 
he read in that treatise, with what he should see in the several 
prisons of that large city. But to his surprise, after visiting 
them all, and finding them full of malefactors, (for the late 
Empress at that time suffered none, who were convicted of 
capital crimes, to be put to death;) he could discover no fever 
among them, nor learn that any acute distemper, peculiar to 
jails, had ever been known there. He observed, that some of 
these places of confinement had a yard into which the prison- 
ers were allowed to come for the air : but that there were 



116 

others without that advantage, yet not sickly." " He conclud- 
ed with saying, that, upon his return to St. Petersburg, he 
had made the same enquiry there, and with the same result."* 
After adverting to this part of Sir John Pringle's dis- 
course, Mr. Howard, in his Account of the State of the Pri- 
sons in England and Wales, (page 94,) adds, " in this an- 
cient capital of Russia, (Moscow,) I found no trace of any 
such prisons, or dungeons, as were common formerly in the 
castles of England, and in several foreign countries." " That 
cruel mode of confinement, in many of our prisons, has been, 
and still is, a principal cause of the Jail Fever ; no symptoms 
of which fever did I see in Moscow, or any part of Russia, j 
He had, however, previously described (at pages 87,' 88, 92, 
93 and 94,) prisons and hospitals in Russia, which he found 
in a very apt state for generating febrile contagion, according 
to the generally received opinion on this subject ; they being 
very foul and close. Near the end of his work on Prisons, 
(viz. at page 467,) Mr. Howard brings the result of his ob- 
servations and enquiries, concerning the cause of the Jail 

• See Dr. Kippis's Edition of Sir John Pringle's Six Discourses, &c. 8vo. 
page 168. 

f This has been confirmed by the Reverend William Coxe, M. A. Sec. who, 
in his Account of the Prisons and Hospitals of Russia, &c. (page 25,) says, " I 
made particular enquiries whether there have been any signs of Jail Fever, or 
Epidemical Distemper, ever discovered among the prisoners in Russia, but could 
not hear of the least tendency to such disorders." This fortunate exemption cer- 
tainly cannot be ascribed to any peculiar advantage in the construction of the Rus- 
sian prisons, or any superiority of cleanliness, because the late Empress Catharine, 
in the answers which she dictated to her secretary, and sent to Mr. Coxe on that 
subject, declares, that " there has been hitherto no general plan for the construc- 
tion of prisons, nor rules for their distribution and situation." — And that " there 
is no more regulation for the cleanliness of the prisons than for their construc- 
tion and situation. By an abuse (she adds) favourable to the prisoners, they are, 
in many places, permitted to go to the baths." — But, she thinks, " it is probable, 
that the cold alone prevents epidemical disorders. — Travels into Poland, Russia, &c 
vol iii. page 133, 8vo. Cold, however, is now certainly known not to produce any 
such effect, in regard to the contagion of Jail or Typhus Fever, which, as ha= 
been already stated, (at page 124, &c-) is equally unknown in the habitations of the 
Russian peasants- 



117 

Fever, to this pointed couclusion. " If it were asked, (says 
he,) what is the cause of the Jail Fever ? It would, in general, 
be readily replied, the want of fresh air and cleanliness : but 
as I have found, in some prisons abroad, cells and dungeons 
as offensive and dirty as any I have observed in this country, 
where, however, this distemper was unknown, I am obliged to 
look out for some additional cause for its production." Mr, 
Howard's further experience, in his subsequent tour over a 
great part of Europe, and into Turkey, in (1785, 6, and 7,) 
being in conformity with his preceding statement, he repeated 
it in the same words, iu his work on Lazarettos. — Page 231. 

This " additional cause," which Mr. Howard thought it 
necessary to look for, in order to explain the production of 
Jail Fever, can be no other than the contagion thereof, which, 
however prevalent in this kingdom, has no existence in most 
other countries, and where it does not exist, there is good rea- 
son to conclude that the true Jail or Typhus Fever never 
occurs, though other fevers have been frequently mistaken for 
it ; this is, doubtless the reason why all those accumulations 
of filth, in close crowded places, do not occasion febrile con- 
tagion in prisons abroad, though in this country, where that 
disorder always exists, they contribute greatly to its reten- 
tion, concentration, and virulence. 

The frequent intercourse between the subjects of Great 
Britain and those of France, by reciprocal captures at sea, 
has been a cause of introducing the Typhus Fever into the 
ships, and among the seamen of the latter. But, as Paris is 
at a considerable distance from the sea coast, there is good 
reason to believe that this fever has been rarely, if ever, known 
in that metropolis ; and that, when it lias occasionally exist- 
ed at any sea-ports, or in the interior parts of France, (as at 
Rouen, see page 71, note,) it has, in general, been originally 
derived from British prisoners. And it was, doubtless, for 
the reason just given, that an eminent and justly-celebrated 
physician, Professor Sauvages, of Montpellier, when he ad- 
mitted the Jail Fever (which he denominates Typhus Carce- 



US 

rum) into his Nosologia Metliodica, relied solely on the au- 
thorities of two English physicians, Huxham and Pringle, 
adopting exclusively their descriptions of the disease, which 
he has mentioned in several parts of his valuable work, but 
always with references to the same English physicians only, 
which probably he would not have done, if, with his very ex- 
tensive reading, he had found any other sufficient authority 
for the existence of this fever, (which, indeed, he does not 
appear to have ever seen,) and for its characteristic symp- 
toms. 

A further proof of the rarity of this /ever, in the interior of 
France, seems to present itself in the ninth volume of the 
Memoires of the " Societe Royale de Medecine," of Paris, in 
which it appears that this society, in November, 1790, pre- 
sented to the National Assembly, a plan of a new Medical 
Constitution in France, — (page 102 ;") and at the fifth section 
of the second part of this plan, which relates to the " func- 
tions du Medecin dans les Depots de Mcndicite ou Maisons de 
travail, et dans les prisons," the following obscr\ation i> 
made, viz. " On suit que faute de propi-ete et de soins, et par 
Pentassement des homines, ou le mauvais traitement des ma- 
lades, les prisons ou depots out souvent ete le foyer d'Epi- 
demies redoutablcs. C'est surtout en *in$leterre qu'on en a 
eprouve les funestes efftts; c'est la qu'on a vu la plus expan- 
sive des contagions s'elancer de ces maisons pour infecter an 
loin les flottes par la presse ; les armees par les recrues faites 
dans les Bridewells, (ou maisons de correction ;) les villes et 
les campagnes par les Sessions des Comtes, k les possessions 
Anglaises dans les iles par la transportation des criminels." 
I ought here to observe, that four or five years before this 
plan was presented to the French National Assembly, Mes- 
sieurs Tenon and Coulomb, two of the commissaries, nomina- 
ted by the Royal Academy of Sciences, for matters relating 
to hospitals, had been sent by the French government to En- 
gland, to obtain information on that subject ; and were hero 
most favourably received, and made acquainted with every 



119 

thing likely to render their mission beneficial. And, among 
other acquisitions of knowledge, they were informed of, and 
persuaded to adopt, the opinions prevalent in this country, re- 
specting the supposed generation of febrile contagion by- 
crowding, filth, and insufficient ventilation, which opinions 
appear to have greatly influenced the Royal Medical Society 
of Paris, in that part of their plan which has been just cited. 
But those who have had opportunities of seeing and compar- 
ing the conditions of the poor, as well as of the streets, houses, 
prisons, and hospitals, of Paris and of London, must be con- 
vinced, that if the causes just mentioned, had been sufficient 
to produce the supposed effect, Typhus Fever would have pre- 
vailed in the former, at least as often, and as long ago, as in 
the latter. And that it could not have been proper or justifia- 
ble in this society, to select and represent England as the 
country in which, above all others, the pernicious effects of 
contagion so produced, had been oftenest, and most fatally 
manifested. 

That there may, however, be no doubt on the subject of this 
comparison, I shall extract, and place in Appendix No. 5, 
certain parts of a large volume in quarto, entitled " Memoires 
sur les Hopitaux de Paris, par M. Tenon, Professeur Royale 
de Pathologie, &c. imprimes par ordre du Roi," (1788;) by 
which it will appear that the Hotel Dieu, of Paris, is not only 
the largest, but the most crowded and filthy hospital on earth ; 
that a single building thereof, called " Batiment Meridional," 
generally contains two thousand six hundred and twenty-se- 
ven patients, crammed together, from four to six in each bed, 
with every circumstance and degree of nastiness, and deficient 
ventilation, so that if such causes could have generated conta- 
gious fever, it must have been there generated, nearly two cen- 
turies ago ; and being once generated by them, it must, from 
their continual aggravation, have been constantly maintained, 
and spread to a greater extent, and with increasing virulence. 

Believing, as I do, that any additional evidence on this 
subject would be superfluous, I shall content myself with ob- 



120 

serving, that the respectable Dr. James Lind, though he had 
allowed himself to adopt and maintain the common opinion, 
that Contagious Fever might be generated by the means 
which have been so often mentioned, has, notwithstanding, 
upon several occasions, stated facts, which, with proper at- 
tention, might have led him to a different conclusion. In his 
chapter on the Jail Distemper, at page 315, of his Essay on 
preserving the Health of Seamen, (second edition, are the 
following paragraphs, viz. 

"The origin of the jail infection is a point, at present, » n 
tirely unknown. No person has given us the least sati 
tory account how or where it is generated. It does not 
to originate in air, and there are many prisons abounding 
with filth and impurities, perfectly free from it. 

"In ships also, an infection is generally imported from tin 
land, and many that have been long in a very dirty condition, 
at sea, bring their men quite healthy into the harbours. — 
Indeed, I have always observed, that the most healthy ships 
were such as arrived from a long foreign voyage, the bcwvj 
being the chief, and almost the only complaint anionic them. 
Whereas ships of war. especially when fitted out in the 
Thames, even in times of peace, very often received this in- 
fection from London." 

And, finally, at page 227 of the same volume, we find this 
assertion, viz. " I never heard of any ship which, after hav- 
ing been carefully and properly smoked, did not immediately 
become healthy: And if, afterwards, they turned sirkl 
was casij to trace that sickness, from other infected ships, 
jails, and the like places." Certainly this would not have 
been the case, if it were possible that contagion should 1>< 
nerated, de novo, as has been supposed, by the rauoca in ques- 
tion. 

From the preceding facts and considerations. 1 think it 
may be safely inferred, that filth, crowding, putrid human 
effluvia, and deficient ventilation, though favourable to the re- 
tention and accumulation of febrile contagion, watte Typhus 






121 

Fever exists, or has existed, and consequently, to its activity, 
do not of themselves either generate, or enable the human 
body to generate, that contagion; and that fevers are not 
contagious, nor liable to become so, unless produced by con- 
tagion. 

Assisted by these inferences, 1 shall next proceed to ascer- 
tain, as far as I may be able, the causes of the Yellow Fever, 
together witli the truth or fallacy of those reasonings which 
ascribe either its origin or propagation to contagion. 



END OF PART SECOND. 



16 



PART THIRD. 



OF THE CAUSES OF THE YELLOW FEVER. 



The Creator of the world, for purposes which it is our 
duty to respect as wise and good, has so constituted the 
surface of the earth, that, in a great part ol it, tin soil, 
when moistened and assisted by suitable degrees of* solar 
heat, is naturally disposed to produce certain vapours m 
exhalations, technically denominated frill miasmata, and 
possessing a specific power of exciting fever in the human 
body, which fever, though most frequently intermitting 
remitting, is a great cause of mortality, especially in hot 
climates. 

This important truth is now so well ascertained, and 
so generally admitted, that many proofs in supj>ort of it 
will scarcely be deemed necessary. Several remarkable 
instances offerers produced by this cause, ha\e hcen al- 
ready stated between pages 8:2 and 88 of this volume, 
and to these it may suffice to add the following. 

Dr. John Hunter, in his Observations on tin' J) is, 
of the Army in Jamaica, informs us, that the place in 
Kingston Harbour in that island, at which •• the shij 
Avar take in their water, being wet and swampy, it com- 
monly happens that the men employed in filling the wa- 
ter-casks are taken sick, either at the time, or a tew t 
after ; and there are examples where, out of h\ \ o. seven- 
ty men sent on that duty not one has escaped a lever. 



123 

Dr. Blane also, in his interesting " Observations on the 
Diseases of Seamen," alluding to the same service, at the 
same place in Jamaica, says, (p. 92.) that "it was the 
practice of many ships of war) to leave the water-casks 
on shore all night, with men to watch them, and as there 
is a land-wind in the night, which blows over some ponds 
and marshes, there were hardly any men employed on that 
duty who were not seized with a fever of a very bad sort, 
of which a great many died." Afterwards, at p. 392, 
when treating of "the bilious remitting fever," the same 
author observes, that it " may generally be traced to the 
air of woods and marshes ; and in our fleet hardly any 
men were attacked with it, but those who were employ- 
ed in the duties of wooding and watering." 

Dr. Lind, speaking of the unfortunate attempt to make 
a settlement at the Island of Balambangan, near Borneo, 
where scarcely one in ten of those sent thirther survived 
the first six months, says, ** from October till April, during 
the north-east monsoon, the wind comes from the sea, and 
the settlement is perfectly healthy ; but from April till Oc- 
tober, during the south-west monsoon, the wind blows over 
the marshes, both of this Island and Borneo, and pro- 
duces fevers of the most malignant nature, which frequent- 
ly cut off the stoutest men in twelve or fourteen hours." 
See his Essay on the Diseases incidental to Europeans in 
Hot Climates, p. 99, 5th Edition. 

And finally, — Nicholas Fontana, who went out as sur- 
geon to an Italian East India ship, in November, 1776, 
in which service he continued five years, and afterwards 
published some judicious observations concerning the dis- 
eases of Europeans in hot climates in the Italian language, 
informs us, that " the ship having arrived at the Bay del 
Agoa, on the Eastern Coast of Africa, in,. March, 1777, 
some tents were pitched along the bank of the river Spir 
rito Santo, which is low and swampy, to accommodate the 
sick of the scurvy, and those who were employed in wood- 



124 

ihg and watering, and that, of forty-seven sailors who had 
slept on shore, there was not one who escaped a vio- 
lent fever, which proved fatal to twenty of their number. 
— " Observazioni intorno alle mallattie che attaccano gli 
Europi ne' climi caldi." P. 11. also p. 76. 

If more proofs of the specific power of marsh miasmata 
to produce fever should he desired, they may be found in 
the treatise * De noxiis paludum effluvis, corumque reme- 
diis," by "Jo. Maria Lancisius Archiater Sanct raL Pa- 
fris Clementis XI. ;" and in the works of Sir John Prin- 
gle, Dr. Lind, Dr. John Clarke, and several other medi- 
cal writers of eminence, as well as of undoubted credit. 

Assuming, then, that these miasmata are a most power- 
ful and frequent cause of fever, it seems expedient to en- 
quire concerning their origin, nature, and constituent prin- 
ciples. 

The exhalations from marshy grounds may be presumed 
to consist, either of pure aqueous vapour alone, or of this 
vanour, combined or intermixed with other vapours, or par- 
ticles resulting or extricated from some of the various mat- 
ters, which naturally constitute the soil, or have been su- 
peradded to it; and we ought, therefore, if possible, to 
certain whether the noxious effects of these exhalations are 
produced by pure water only, either dissolved or diffused 
in the atmosphere, as some respectable authors have assert- 
ed, or whether they are solely or principally occasioned 
by any other matters extricated from the earth ? 

There are two modes or forms in which water may ex- 
ist in the atmosphere; one is that of a complete dissolu- 
tion by the air, so as to be rendered invisible to the 
and sometimes insensible even to the nicest hygrometer ; 
the other is that of very small globules, commonly percep- 
tible to the eye, and disturbing the transparency of the 
atmosphere, as in what is called mist or fog. 

If pure aqueous vapour in the former of these states wei-e 
really a cause of fever, we should uniformly dis-coxer that 



125 

sailors are, and have been, more liable to that disorder on the 
ocean than when on shore, or in harbour; since it may safely 
be affirmed that the atmosphere at sea is more saturated with 
aqueous vapour, than it can be on shore, because a much 
greater, evaporation must necessarily take place from a vast 
expansion of water, than ever occurs from an equal surface of 
land, not covered, or not nearly covered, by water. It is, 
however, notorious, that if vessels are not sent to sea in an 
improper condition, their crews are generally much more 
healthy on the wide ocean than in any other situation. Dr. 
Lind, in his Essay on Preserving the Health of Seamen, 
(p. 218,) states, as a general proposition, confirmed by long 
experience, "that persons at sea are less subject to fevers 
than those at land." Dr. Blane, also, in his work on the 
Diseases of Seamen, says, (p. 252,; " The air at sea in 
those climates, (West Indies) as well as every where else, is 
extremely pure and wholesome, and there is no where that 
seamen are more healthy or comfortable." He had previous- 
ly made a similar, and, in regard to "violent fevers of hot 
climates," a more pointed assertion at p. 204. 

To these testimonies may be joined that of Dr. John Hun- 
ter, who (at p. 14 of his Observations on the Diseases of the 
Army in Jamaica states,) that " simple moisture is harmless, 
at least as far as relates to the production of fevers, of which 
the two last mentioned places (Fort Augusta and Port Royal) 
may likewise be given as examples, for they are nearly sur- 
rounded with Avater on all sides." He adds, " It is true the 
air is perfectly clear, yet it must be loaded with moisture in 
consequence of the great heat of the sun acting upon the 
water." And finally, not to tire my readers with superfluous 
testimonies, I shall content myself with adding that of Dr. 
Gillespie, who, in his Observations on the Diseases of his 
Majesty's Squadron on the Leeward Island Station, between 
1794 and 1796, states, (page 20) as the general result of his 
experience, that " a ship of war is rarely affected with a 
sickly crew at sea, in the West Indies, and as rarely con- 



\2t> 



tinues a fortnight in port without some of the seamen being 
attacked with fevers and fluxes." 

It seems probable, however, that the morbid influence, 
which was attributed by the late Dr. George Fordyce, to pure 
water, in exciting fever, was principally intended to be under- 
stood of aqueous vapour merely diffused through the atmos- 
phere, in the form of mist or fog : and as his Dissertations 
on Fever, which promulgate or assert this doctrine, are 
amongst the most valuable medical works produced in this 
country, it may be expedient to examine this part of the sub- 
ject more minutely, in order, if his opinions respecting it 
should be erroneous, to obviate that extensive adoption of 
them, which his high authority might otherwise obtain, upon a 
question of great importance. 

The following are Dr. Fordyre's reasonings and si 
ment on this subject, at page 146 of Ihs Dissertation on Sim- 
ple Fever, viz. " A man going into water of a moderate 
temperature, and remaining in it for some time, has not beep 
found more frequently afterwards affected with fever, than 
after standing, walking, or any other indifferent circum- 
stance. It is certainly, therefore, not the application of 
the water to the body that gives occasion to the rtincaar ; but 
if the air has particles of water floating in it, and a man 
has continued for some time in such an air, fever lias ensued 
much more frequently than when he had lived in a dry air." 
Hence the author is led to conclude, that moisture must be a 
cause of fever ; and that he may persuade his readers to adopt 
the same conclusion, he assumes the following unsatisfactory 
proposition, p. 151. " If those, who contend that the appli- 
cation of water suspended in the atmosphere, in the form of 
moisture, does not produce fever, were to live a year or two in 
Batavia, they would be convinced, by fatal experience, that 
men living in a moist atmosphere are more frequently affected 
with fever than in a dry one." Surely, if Dr. Find; 
opinion on this subject were just, those who thought differ- 
ently from him might have been made sensible of their error 



127 

by less inconvenient and dangerous means than a voyage te* 
and residence at, Batavia. The author then proceeds as fol- 
lows : — " Moisture in the air produces more fevers, the 
warmer the atmosphere; but moisture produces fever in all 
temperatures. The Dutch have endeavoured to make the 
country of Batavia resemble Holland in the immense number 
of its canals. The consequent moisture of the atmosphere is 
very great in both places ; but although fevers, therefore, fre- 
quently occur in Holland, they bear no comparison in num- 
ber to those which happen in Batavia, where the fatality, 
owing to the moisture and heat of the climate, is so great, 
that it is wonderful any person should even approach that 
settlement but from the absolute impossibility of otherwise 
obtaining water or food." This proof of the effects of mois- 
ture I cannot but consider as entirely gratuitous, because, to 
use the words of Sir George Staunton,* (whose description 
agrees with those given by Captain Cook and other respect- 
able navigators) the settlers at Batavia live " in the midst of 
swamps and stagnated pools; from whence they are every 
morning saluted with ' a congregation of foul and pestilential 
vapours, whenever the sea breeze sets in and blows over this 
morass;" and, before Dr. Fordyce could have been warranted 
in ascribing the violent fevers which are so common in that 
settlement to moisture alone, he ought to have proved, that in 
such a situation no other causes existed by which they could 
have been produced.! 

* An authentic \ccount of the Embassy to China. Vol. i. p 242. 

.»- Dr. Horsefielri, an American physician, who now is, or lately was, employed in 
ravelling over the Island of Java with the sanction of the government of Batavia, ob- 
serves, in an account of his voyage to that island, in the year 1800, (published in Dr. 
Cox's Medical Museum, vol. i p. 75, &cc.) that "it is impossible for the imagination 
to conceive a situation more favourable to the production of marsh miasmata than that 
of Batavia. "If," adds he, "human industry and ingenuity should be exerted in 
planning and constructing an elaboratory for the production of pestilential vapours, a 
situation exactly resembling that of Batavia and its environs would be the result." 
But even here Dr. Morsefield states the rainy season to be " comparatively healthy," 
fp those who have it their power to avoid immediate " exposure to rain ;" contrary to 



128 

The author next allows, that " fevers more frequently arise, 
'when the moisture is evaporated from a marshy country, or 
from stagnating water, than when it proceeds from the sea, 
large lakes, or rivers confined within their banks, and run- 
ning with a rapid stream. H This," says he, " has given oc- 
casion to suppose, that some other vapours proceed from 
marshes besides water, and produce the disease." But as 
such a notion must clash with his own hypothesis concerning 
simple moisture, he brings forward a second proof, to show 
that fevers have been produced by moisture, when it has 
arisen from the earth in a state of purity, that is, not impreg- 
nated with any of the matters contained in the soil whicli are 
undergoing the process of decomposition. u It certainly hap- 
pens often," he says in page 154, "that a considerable degree 
of putrefaction takes place in marshy gmands, and more es- 
pecially in warm climates ; but it is by no means to be ron- 
cluded, that moisture in the atmosphere always produces fever 
in consequence of putrefaction. Putrefaction can only take 
place in animal or vegetable substances. If water, therefore, 
not impregnated with either, should be in such a situation as 
to produce moisture in the atmosphere, no putrefaction i .in 
take place; therefore, if fevers ensue, they are certainly in 
consequence of moisture, not putrefaction. Many insta 
of this may be brought, as in the war which took pi a 
Flanders, between 1710 and 1711, an army encami>ed ujm>ii 
a pure sand, in which water was found in digging less than a 






that which must have been the case had the doctrine of Dr. Fordvce been true,— and 
Dr. Horsefield assigns as the reason of this greater healthiness during the rains, that 
the rivers and canals are then " plentifully supplied with water, which flows through 
them with considerable rapidity, and most of the lower marshy situations are emireU 
inundated with water." But in July, August, and September, these waters !• 
nearly evaporated; and "the quantities of marsh miasmata no~i- produced, are not 
only inconceivably greater than at other times, but the diseases produced by them are 
much mora malignant and intractable in their nature." And this f which if Dr For- 
dyce's opinion were just, ought to be the season' o healthj b« comes, to M 
Horsefield's own words, « the season of death and destruction, in which the h 
and church-yards are filled." 



129 

foot defy), and occasioned a great moisture in the air, which 
produced in a few days numbers of fevers, although the army 
was perfectly healthy before, and no more fevers were pro- 
duced on shifting their ground." 

This last instance, apparently more decisive than the for- 
mer, is, however, of a very questionable nature in several 
respects. Tt would be injustice towards Dr. Fordyce, to sup- 
pose that he could have stated this as a fact, if he had not been 
persuaded that it had really happened, and exactly as he has 
related it ; but, unfortunately, he neither mentions the spot 
where it occurred, nor the author by whom it was related, and 
who might have been greatly misinformed or deceived as to 
the circumstances ; and every one will agree in this, that no 
fact which is to serve as the foundation of an important doc- 
trine, can have any claim to be received into a philosophical 
discussion, unless it be fully attested. Now, with regard to 
the alleged purity of the sand, on which the camp was pitched, 
I may observe, that it is extremely difficult, not to say impos- 
sible, to find any soil that does not contain some portion of ve- 
getable and animal matters ; and that, even if these had not 
previously existed in the sand, they would have been immedi- 
ately supplied by the army encamped thereon, and being as- 
sisted by the moisture abounding there, would have very soon 
afforded vapours, differing greatly from those of pure water. 

But supposing the sand on which this encampment was 
made to have been perfectly pure, still there may have been 
marshy ground at a small distance, whose exhalations might 
have caused the fevers in question ; and it is not assuming too 
much to say, that, in a flat country like Flanders,, wherever 
any ground is so low and wet that water is found at less than 
a foot beneath the surface, the surrounding land is likely to be 
very marshy. Moreover, as the fevers broke out among the 
troops only "" a few days" after they had encamped on the 
sand, there is more than a possibility that they were caused, 
not by the unhealthiness of their actual position, but by that 
of tl?e station which the army had recently quitted $ and one 

17 



130 

need only read the description which Sir John Pringle lias 
faithfully given in his work on the Diseases of the Army of 
that part of the Netherlands in which military operations 
have been mostly carried on in modern times, in order to be 
convinced, that a very large portion of the surface of that 
country consists of marshy ground. 

Such are the objections which occur to this second instance, 
as it stands in the Dissertation on Simple Fever; and with 
these I should have dismissed the consideration of it, as being 
of too doubtful a nature to deserve much notice, if Dr. For- 
dyce had not adduced a similar fact in support of the same 
doctrine, after a lapse of eight or nine ycai*s, which I .shall 
quote in his own words, from page 63 of his " Fourth Disser- 
tation on Fever," viz. " The author has shown, in a former 
dissertation, that moisture, by dissolving in the air, or by eva- 
poration, is one powerful cause of fever; that it is often the 
cause of intermittents, as well as of the other diseases which 
have been above enumerated," (dysentery, continued or re- 
mitting fever, and irregular scmitertians, under which la*t 
title he includes the disorder now known by the name of the 
Yellow Fever) " without any putrefaction taking place, is cer- 
tain, from several instances. These diseases have been pro- 
duced in countries where the water was found at only a foot or 
two under the surface of the earth, whence the moisture has 
arisen and contaminated the air, so as to occasion these dis- 
eases, while the soil has been perfectly dry,* and there has 
not been the least appearance of putrefaction, the country be- 
ing clear from woods. In this case it could be nothing but 
the moisturef that produced the disease. One instance of this 
occurs in the encampment of the English array in the \\ ar 
about the year 1745, in a sandy plain in Flanders. Another 



* Either the soil was not perfectly dry, or so much moisture did nut rue through it, 
as to produce a morbid contamination of the air. 

f Th:s is rather an basts assertion, ^ince it is obvious, that soils, uj>on which not a 
single tree is growing, may nevertheless contain putrefying animal and vegetable 
substances in considerable quantity. 



131 

In a region of Pern, where water is every where to he found at 
about seventeen inches below the surface of the earth, though 
the country itself is barren for the want of water, and uninha- 
bitable from the number of dysenteries and semitertians which 
take place in it." 

The only difference between these two encampments on a 
plain of sand, is that of the dates, concerning which a mis- 
take might easily have been made by one who has often stated 
facts very loosely ; and for this reason I am inclined to be- 
lieve, that Dr. Fordyce alluded to the same fact, while he was 
writing each of the passages I have quoted. With this idea I 
naturally recurred to Sir John Pringle's excellent Medical 
History of the War, between 1742 and 1748, where I expected 
to find the account of this encampment; but neither in this 
work, nor in any other I have met with, relating to the trans- 
actions at this period, have I been more successful in disco- 
vering the object of my inquiry, than I had been before in the 
many searches which I bad made after the instance said to 
have happened in the former war.* There are, however, 
certain passages in Sir John Pringle's book, which appear in 
some measure to correspond with Dr. Fordyce's statement, 
and they are, perhaps, the instances which the latter author 
had in his mind on both occasions. Sir John Pringle, de- 
scribing the face of the northern part of Dutch Brabant, says, 
it| " is nearly as flat as any ground of the Netherlands, the 
only inequalities being some sand-hills and insensible risings, 
which give the advantage of a few feet in height to some of 

* Among other endeavours to ascertain the circumstances which Dr. Fordyce ought 
to have stated, in regard to his supposed facts, I applied to Dr. Wells, who had edited 
the latter part of his work on Fevers, hoping that, either from the papers of Dr. 
Fordyce, or from their conversations, Dr. Wells might be enabled to supply the 
desired information. The latter gentleman, however, in a letter dated the 30th of 
April, 1806, declared himself unable to do this; politely offering, at the same time, 
to " make inquiry among others of Dr. Fordyce's friends, and, should it be suc- 
cessful, to communicate the result." No such communication having since been rer 
ceived I must necessarily conclude, that the promised inquiry has proved fruitless; 

f Observations ou the Diseases of the Army. Page 62, 7th Edition. 



132 

the villages. The soil is a barren sand, and so little water is 
seen, that, at first sight, the country might seem to be dry 
and healthful. But this appearance is deceitful, for water is 
every where to be found at the depth of two or three feet ; 
and in proportion to its distance from the surface, the inhabi- 
tants are free from diseases." After this the author mentions 
that, during the summer of 1748, the troops which were can- 
toned in different towns and villages became very sickly, and 
that " the sickness was much greater near Breda and Bois- 
le-duc than at Eyndhoven, which lay at a greater distance 
from the inundations, and from other marshy grounds.' 9 The 
following inference comes next, which seems to me to have- 
no necessary connexion with what immediately proceeds, and 
to be not only erroneous, but liable to considerable misinter- 
pretation, viz. w The moisture, therefore, in most of the can- 
tonments arose principally from the subterraneous water 
which exhaled through the sand." Let us now examine if this 
account can be fairly construed into a proof that pure moisture 
was the cause of this sickness."* " On the 10th of May, 
1748, the army left Hillenraet, near Roermond, and in a lew 
days came to Nistleroy," (or Nesterle, which is situated in 
the centre, as it were, of the North of Brabant) " where they 
encamped for the last time ;" and. *• on the ninth of July, the 
camp broke up, and the troops went into cantonments;" the 
war being then at an end. During this intervalf "some sea- 
sonable rains, with thunder and lightning, seemed to prevent 
any sultry heats ; the ground besides was dry, and the camp 
airy, so that the sickness was inconsiderable as long as the troops 
kept the f eld " This is the only encampment which I can 
discover to have been made on a sandy ground in the course 
of the war; but, surely, this cannot be cited as the example in 
which " numbers of fevers were in a few days produced 
among troops previously healthy, in consequence of their be- 
ing encamped on a pure sand, where water was found at km 



Page 60. 



Pagp 61. 



133 

than a foot deep." Nor does the account given by Sir John 
Pringle, of the health of the army subsequently to this en- 
campment, at all coincide with Dr. Fordyce's statement, that 
" no more fevers were produced on shifting their ground :" on 
the contrary, so many fevers broke out, that* " the troops 
had scarce been a month in the cantonments when the returns 
of the whole sick were increased by two thousand, and after^ 
wards they rose considerably higher." Besides the army,f 
fethe- peasants were great sufferers," from these epidemic fe- 
vers. " This country," says the author, " had not known so 
much distress for a number of years, as two such causes" (of 
disease) " had not occurred, I mean the drying np of the inun- 
dations," which had been made about the fortified towns, since 
the commencement of the war, " with a hot and close summer 
and autumn." I shall not here inquire what effects might 
have resulted from the operation of these causes, because the 
inquiry more properly belongs to another part of this work, 
where it will probably appear, that two such causes as thesQ 
were fully capable of producing the fevers in question : but 
having shown, from the best authority, that the health of the 
army was comparatively good during the only encampment 
which is recorded to have been made in the course of the war 
between 1742 and 1748, "on a sandy plain, where water was 
found at the depth of two or three feet :" and having also^ 
shown, that the sickness which ensued shortly after the camp 
was broken up, among the several divisions of the army, can- 
not, with any justice, be ascribed to the transpiration of sim- 
ple moisture through a pure sand, since it is even stated by 
Sir John Pringle himself, who seems to have been an advo- 
cate likewise for the noxious properties of moisture, to have 
been proportioned to the distances of the different canton- 
ments "from the inundations and other marshy grounds." 
I shall now examine the validity of the third instance, con- 
cerning the unhealthiness of " a region in Peru," which Dr. 

* Page 66. -J- Page 67. 



134 



Fordvce has annexed to his second account of the encamp- 
ment on a plain of sand. 

The air of improbability which accompanies his descrip- 
tion of the region in question, (which certainly ought to have 
been designated by its proper name) will immediately be 
perceived by the reader. "Water," says he, "is every 
where to be found at about seventeen inches below the surface 
of the earth. — The country itself is barren for want of wa- 
ter ;" yet so much moisture transpires through the ground, as 
to render the spot " uninhabitable" Surely, if so much aque- 
ous vapour passed through the earth as to communicate to 
the atmosphere a morbid excess of humidity, the soil itself 
could not have been so extremely dry as, from that very cir- 
cumstance, to be rendered barren ; warm dry earth would, 
undoubtedly, absorb some portion of the aqueous vapour 
in question during its passage ; and we may safely infer, 
that, so long as the soil remained dry, the vapour which 
arose from the subterraneous water must have been too lit- 
tle for its saturation, and consequently, insufficient to load 
the air with a noxious degree of moisture. But neither this 
objection, nor such of the objections advanced against the 
preceding instance, as are applicable to the present i 
deterred me from endeavouring to discover if any part of 
Peru answered the description given by Dr. Fordvce of this 
particular region : and since the author, who never was out 
of Great Britain, has, on this occasion also, neglected to 
mention whence he derived his information, and none of his 
surviving friends are able (so far as I can learn) to supply 
the omission, I had recourse to the best accounts hitherto 
published of that most singular and interesting country. 
(Peru,) particularly to those of Don Antonio Ulloa, who, 
to the rank of Lieutenant- General in the Spanish Navy, 
and Naval Commandant in Peru, added scientifick attain- 
ments sufficient to procure his adoption into most of the 
learned societies in Europe. This distinguished author lias 
given a narrative of his voyage with Don George Juan and 



135 

1he French Academicians, who were sent by the Govern- 
ments of Spain and France to South America, in 1735 ; and 
lie afterwards published some observations on Peru and other 
parts of America, in Spanish, under the title of " Noticias' 
Americanas," of which a translation in French, was printed at 
Paris, in 1787, with the title of " Memoires Philosopliiques, 
Historiques, Physiques, concernant L'Amerique, &c." It is 
more especially from the latter* of these works, that the 
following account of what Dr. Fordycc would probably, 
call "the regions" of Peru, is extracted. The western 
coast of South America, adjoining the Great Pacific Ocean, 
consists of low land, which forms a kind of zone along the 
shores of that ocean, varying in breadth from eight to twen- 
ty leagues, and extending from 7° or 8 of North Latitude, 
to 27° or 28° South of the Equator, the whole of which 
bears the name of " Valles." " Au point ou fmissent ces 
plats pays coinmencent les Cordilleres," an immense chain 
of mountains, which runs southward almost to the Streights 
of Magellan, and occupies at its base a breadth of from 
thirty to fifty leagues. Upon this great mass of mountains 
are found large habitable tracts, called Sierras, to distin- 
guish them from the low land on the coast; and we learn 
that these tracts, which Ulloa.has named, "La Parfie haute 
Habitee," are at an elevation of 4536 varas, (of Castile, or 
12,451 English feet) " au dessus des terreins qui avoisinent 
immediatement a la mer." "On voit par la, que cette partie de 
l'Amerique a une bande de terrein sensiblement plus elevee, 
que toutes les autres cont) ees habitues du globe." " II y a dans 
la partie haute habitee, des royaumes tres etendus, des pro- 
vinces fort peuplees ; il s'y voit aussi de vastes contrees de- 
sertes." This high ground, however, serves but as a base 
for an higher range of mountains : " les cimes des montagnes 
qui s'61event sur cette meme plaine elevee,f ont plus de 6,600 

* And from pages 22. 23, 24, 28, 29, 37, 222, 244, of the first vclnme. 
t The snmmit of Chimboracon is stated to be 19,595 feet, above the ocean. 



136 



varas de haut (18,117 feet;) elles surpassent done les autres, 
de 2,063 varas (5,664 feet.)" These surperincumbent moun- 
tains, far exceeding all others on the surface of the globe, 
and eternally covered with snow, are, of course, uninhabit- 
ed, and therefore cannot be the objects of our present consi- 
deration : neither is it the " Partie haute Habitee,*' the ob- 
ject of it, since according to Ulloa, " on n'y voit ni fievres 
intermittentes, ni putrides." Besides these parts, there are 
ravines, extending in different directions through the Sierras, 
which he thus describes. "Dans la partie ele\ee, la tent! 
est entrecoupee de vastes profondeurs, qu'on y appelle Que- 
bradas." " Le fond sert de lit aux eaux qui y coulent. et tien- 
nent prcsque toujours le milieu. Ces eaux suivent les detours 
et les deviations du terrein lateral — fc continuent ainsi leurs 
cours dans ces profondeurs entrc les montagnes. & arrivent 
enfin dans la partie basse du terrein, d'ou elles se rendent a 
la mer; mais la masse d'eau qu'elles forment dans ceti- 
conde partie a peu de profondeur, & semble n etre repanduc 
que sur la surface du sol.." These Quebradas. as Ulloa be- 
lieves, have been gradually worn by the torrents, which have 
descended for a long succession of ages from the heights ; 
they vary in their depth and breadth, the perpendicular depth 
of come of those chasms being 1,769 varas, (4,855 feet) or 
even more, and their width sometimes exceeding two leagues, 
so that " Elles ont assez de surface pour devenir le local de 
nombre d'habitations fort peuplees, qui en tirent tons le* 
produits necessaries a la vie f and their soil is moreover 
sufficiently rich and fertile to permit an extensive cultivation 
of the sugar cane. It is true, that intermittent fevers 
dangerous kind are occasionally seen in the Quebradas. from 
causes which produce them in other countries : tin - 
however, are neither uninhabited nor barren, but exactly the 
reverse, and, therefore, we cannot consider them as & 
healthy region which Dr. Fordyce meant : nor does there 
* appear, from the accounts I have met with, to be any i 
part of Peru to which he could ha\e alluded, except the 



137 

Country lying between the sea and the foot of the Cordille* 
ra3. Upon this low country of the "Valles" it is remarka- 
ble that no formal rain ever falls ; but there are wetting fogs, 
called "garuas," during what is there named winter $ and as 
" le sable domine dans les terrains has, nieme a des distances 
assez considerables*" one is at first led to suppose, that the 
soil must here be barren for want of water ; but it will be 
immediately perceived, that this is far from being the case. 
During about one half of the year, viz. from July to Janua- 
ry, which is called winter in the low lands of Peru, the 
ground receives an ample supply of moisture for all the pur- 
poses of the most luxuriant vegetation, by a contrivance of 
nature, no less singular than bountiful : while this season 
continues, the low country is constantly covered with a thick 
fog, through which the sun is scarcely ever able to penetrate ; 
and this fog, although not sufficiently damp to wet one's 
clothes, yet is ntt)ist enough **« pour pen trer la terre, pour fer- 
tiliser le sol le plus aride e le plus sterile de sa supcrficie, par- 
ceque le soleil nc pent la dissechcr." During the rest of the 
year, which is the rainy season in the high lands, and is there 
termed the winter, the eavth is likewise supplied with mois- 
ture, by means of artificial irrigations, which appear to have 
been in general use among the Peruvians, long before the dis- 
covery of America by Columbus. At this time numerous 
streams are pouring through the Quebradas into the low 
eountry, where many of them lose a part of their waters 
in irrigating the land. " Comme on y a le degre de chaleur 
requis, (says Ulloa) il ne s'agit plus que d'y faire des petits 
eanaux pour conduire l'eau ou il est necessaire ; ainsi de ter- 
rains steriles on en fait des campagnes, dont la fertilite ne le 
cede pas aux terras les plus grasses." We must also take no- 
tice that these streams do not all discharge themselves into 
the sea: some of them which happen to flow into situations 

* Voyage Ilistorique de l'Amerique, par Don Geo. Juan & Don Ant de Ullo»> 
Tom. i p.45i. 

J8 



138 

so low, that " les terrains n'ont pas assez de pente pour leur 
ecoulement," are there arrested in their course ; and at these 
places the ground becomes swampy ; it is from this cause thai 
" on voit dans les terrains has quclques eternities de terra fan- 
geuse." After this description of the low country, we cannot, 
certainly, be surprised at learning, that intermittent fevers 
occur frequently among its inhabitants : we find, however, 
that even these fevers do not correspond with the account 
which Dr. Fordyce has given, either of the nature, or of the 
cause of them; for Ulloa says, that " Dans la partie I). 
ces fevres ne sont point dangercuses, quoique longw 
fatiguantes :" and it is unnecessary to observe, that fevers of 
this mild nature are not likely to depopulate a district : and, 
in regard to their cause, it could not he asserted, with truth, 
even if the country had been rendered uninhabitable by le- 
vers, that these were produced by pura moisture, since, al- 
though sand may predominate in the low Wands, as Ulloa 
states, yet the soil is not exclusively composed of Band, and it 
cannot be imagined, that pure aqueous vapour could alone be 
exhaled from a tract of country, of which a considerable 
part consists of land which is not only cultivated, but i 
dered extremely fertile by copious lh d in which 

there also appear to be some ext 

ground. Hence we must be convinced, that Dr. Foi 
has been as little correct in referring us to Peru, as in send- 
ing us to Batavia, in search of the noxio,; 
pie moist v. re. 

The Reference which I conceived to be due to the opini 
of this author, especially when they seemed to he corn 
rated, so far as regards the tendency of moisture to produce 
fever, by those of Sir John Pringie, and some otfaei 
table physicians,* and tiie importance of the subject its 



* Even Dr. ! inn, overl-okin^ many facts of a contrary import, stated bv himself, 
appear* to have adopted a.; opinion similar to that wh.ch 1 am now controverting. 
In his work ot, " the Diseases incidental to Europeans in Hot ( Imv edition) 

M-e find, at page 9, this passage, viz. « In my Essay on preserving Seamen I hare 



139 

Save drawn me into a long examination of the proofs adduc- 
ed by the former writer, in order to point out their insuffi- 
ciency. It may, however, here be mentioned, that Dr. For- 
dyce, although he entertains no doubt concerning the validi- 
ty of his proofs, nevertheless finds great difficulty in account- 
ing for the allcdged effects of moisture; and, towards the 
close of his discussion* of this subject, after repeating an 
observation already quoted, viz. that since water is innocent 
when applied to the body in a mass, as during immersion, 
but causes fever when applied in the form of small particles 
floating in the air, " it cannot be the mere application of the 
particles of the water that produces the disease f 9 he says, 
"it must, therefore, be something that they apply to the body 
which occasions it ;" — but " what this may be/' he confesses, 
"is not very clear.'" He afterwards throws out an idea, 
that, " as the evaporation of water produces cold, moisture 
may only be a means of suddenly applying cold to the body," 
and that the cold so produced may be the cause of the fever; 
aware, however, of some objections to this idea, especially, 
as he had previously stated, that heat rendered the moisture 
more noxious as a cause of fever, he concludes with saying, 
" but this the author leaves to future experiment and discus- 
sion.'' From expressions so full of uncertainty, and, I may 
say, of contradiction, it is evident that he was by no means 
satisfied as to the soundness of his favourite doctrine ; and his 
doubts on the subject would have been still greater, if he had 
recollected a very interesting fact, related in page 57 of Sir 
John Pringle's u Observations on the Diseases of the Army," 
(from which Dr. Fordyce, as I have already said, seems to 
have intended to borrow his second instance, relative to the 
encampment on a plain of sand) which is so demonstrative of 

said, that a malignant fever of the remitting kind, most frequently a double tertian, 
is the genuine produce of heat and moisture, is the autumnal fever of all hot countries, 
and is the epidemic disease between the tropics : to which I may add, that it U also the 
disease most fatal to Europeans in hot climates." 

* Dissertation on Simple Fever. P. 156. 



140 






•the opposite effects of pure moisture, contrasted with those of 
marsh effluvia, that no apology can be necessary for introduc- 
ing it here. 

According to Sir John's statement, four battalions, of about 
seven hundred men each, were stationed in the two islands of 
Walcheren and South Beveland, during the very hot summer 
of 1747. These islands are from one to two miles asunder, 
and form part of Zealand, which province (p. 2.) u is not only 
low and watery, but surrounded with the oozy beaches of the 
Eastern and Western Schcld. and the most, marshy pacta of 
the country," (the United Provinces and Dutch Brabant 
along the Maes) "so that almost every wind, except from the 
sea, adds to its native moisture and unwholesome exhala- 
tions. 5 " Under such unfavourable circumstances of situation 
and of season, the troops, " both in the field and in quai i 
became so very sickly, that, at the height of the epidemic, 
some of those corps had but one hundred men fit for duty, 
and the Royals in particular, at the end of the campaign, had 
but four men who had never sickened. But Commodore 
Mitchel's squadron, which lay all this time at anchor in the 
channel between South Beveland and the Island of Walchc- 
ren, in both which places the epidemic prevailed, was neither 
afflicted wiili the fever nor the flux; but amidst all that sick- 
ness enjoyed perfect health ; a proof," as the author justly 
observes, " that the air of the marshes w as d issip a t ed, or cor- 
rected, before it could reach them." This account, had it 
been known to Dr. Fordyce, or remembered by him, would, 
probably, have weakened his confidence in the power of 
moisture to produce fever; for he would, I presume, have 
readily acknowledged, that the atmosphere could not have 
been less moist (and he might have found, that it was more 
moist) where the squadron lay at anchor, surrounded as it 
was by water, than in those islands; and. consequently, that, 
if simple moisture had been the real cause of the fevers which 
were S o prevalent on shore, the sailors must have suffered at 



141 

least equal sickness with the soldiers.* But his confidence 
therein, would, perhaps, have ceased altogether, if he had 
attended to the well-established fact, of which it cannot be 
supposed that this author was ignorant, that the occurrence 
of marsh fevers may, with certainty, be prevented, by laying 
the marshy grounds under water ; an operation which cer- 
tainly would not diminish the humidity of the atmosphere. 
But proofs still more convincing, if possible, than the two 
just mentioned, may be offered in refutation of Dr. Fordyce's 
doctrine. Indeed, we know that the air which passes over, 
or is incumbent upon marshes, during winter, in this cli- 
mate, is generally harmless in regard to the production of 
intermitting or remitting fevers, although it is then com- 
monly more replete with moisture, than in summer. And, 
moreover, persons who live on peat-bogs or moors, are, at all 
seasons, for reasons to be explained hereafter, completely 
exempt from the fevers to which the inhabitants of marshy 
grounds are subject ; although it cannot be pretended, that 
less moisture is evaporated from the surface of the former, 
than from that of the latter. Again, every one can recollect 

* A similar exemption from the fevers raging epidemically in the Islands of Wal- 
cheren and South Reveland, occurred in regard to the people on board of the British 
ships belonging to the late expedition against Zealand. This fact, concerning which I 
have received numerous corroborating testimonies, from respectable officers employed 
on that service, has been officially declared in the report made to the Secretary at War 
from Middleburgh, the lUlh of October, 1809, by Dr. Blane, Dr. Lempriere, (physi- 
cian to the Army) and another medical officer, who were sent by his Majesty's go- 
vernment to Walcheren, for the purpose of investigating the nature and causes of the 
malady prevailing among the troops in that island, wherein they state, that they had 
" ascertained that the crews of the vessels stationed in the very narrow channel, only 
a few yards from the land, between Bevelandand Walcheren, have continued perfectly 
healthy during the whole campaign ; thus decidedly proving that the noxious exhala- 
tion is nearly confined to its original source." See the " Military Papers relating to 
the Expedition to the Scheldt, presented by his Majesty's command to both Houses 
of Parliament, February, 1810." Marked E. page 110. Certainly the crews of the 
ships in question, (between Beveland and Walcheren) who continued in health, must 
have been exposed to at least as much moisture, as the soldiers labouring under fever 
on shore. 



142 

a multitude of instances in which persons have heen exposed 
for hours together in the heavy mists which arc frequent in 
this climate during the winter, without having- been after- 
wards attacked by fever. But the remarkable healthiness of 
the men employed in the Newfoundland fisheries, where, as it 
is well known, they are generally enveloped in the dampest 
fogs for several months together, affords the least ambiguous 
proof, within my knowledge, that the atmosphere, when 
loaded with pure moisture only, has no greater power of 
causing fever, than it has when in any usual state of dryi 
" It is difficult," says that celebrated astronomer, Mr. < 
sini, in the account he has given of his voyage to Newfound- 
land, " for one who was never there, to form an idea of the 
life the fishermen lead at the Great Bank. It must be no I 
powerful a motive than the thirst after gain, which can pro- 
vail upon these poor wretches to spend six months between 
the sky and water, in a climate where they are almost alw aye 
excluded from the sight of the sun, and constantly breathing 
so thick a fog, that they can hardly see from one end of the 
ship to the other." Page 125.* In such an atmosphere then, 
if any where, we might expect to find the effects of moisture 
on the human body, manifested and exemplified in the most 
decisive manner; but fevers, or other severe disorders, are so 
little to be included among those effects, that Dr. Lind. after 
mentioning " the surprisingly healthy state of the ship's com- 
panies, who annually visit the Banks of Newfoundland," adds, 
"it is a constant observation, that the men belonging to the 



* The waters which issue from the Gulph of Mexico, forming what is cxnmonly 
called the Gulph Stream, flow with considerable rapidity near the Ranks of Newfound 
laud, bringing with them a temperature of from six to ten or twelve degrees \ 
than that of the super-incumbent atmosphere, and of the sea itself in that part of the 
ocean, according to the season of the year. This superior heat in the Gulph Stream, 
aided by its motion, produces a copious evaporation of aqueous particles from the sur- 
face, which arc immediately condensed by the coldness of the air, so as to produce those 
fogs which, during summer, prevail on the Newfoundland station, to a gn 
probably, than in any other part of the globe, unless it be in the " vafft >•" oil' 



143 

Newfoundland fleet, return every autumn to England with 
much more healthy and robust constitutions than they left it." # 

From the preceding remarks I deduce these conclusions, 
viz. that pore water existing under any form in the atmos- 
phere, does not cause fever; therefore, that marsh exhalations 
would be innocent, if they consisted merely of simple mois- 
ture ; and finally, that, since these exhalations do produce fe- 
vers, they must contain some other matter than moisture, 
which imparts to them the noxious qualities they possess. 
This leads me to inquire what this matter may be. 

The substances which compose the soil of marshes differ 
little, if at all, from those Which are found in other soils, and, 
according to the most recent investigations of chymists, they 
seem to be the following, viz : calcareous, siliceous, and ar- 
gillaceous earths ; sometimes magnesia, oxide of iron, and 
vegetable and animal matters, in various proportions, with a 
few saline compounds, (often in quantities so small as not to 
be easily detected) and water ; but they differ as to their rela- 
tive quantities ; the proportions of the water and of the ve- 
getable and animal matters, compared with the other ingre- 
dients, being much greater in marshy than in dry soils. If 
these various substances be classed according to their respec- 
tive kingdoms, we shall readily perceive that none of those 
which belong to the mineral kingdom, can constitute the va- 
pours which arise from marshes, because none of them is able 

♦See Dr. Land's Essay on the Diseases incidental to Europeans in hot climates- 
Pages 30, 31. Since the above was sent to the press, the author being at Falmouth, 
on his way to Jamaica, vent to one of the copper mines at St. Dye, about ten miles 
distant, into which he descended with several gentlemen, his fellow passengers, move 
than 120 fathoms, and remained there three hours, in an atmosphere so overloaded 
■with moisture that the clothes, with which they had been supplied for the descent at 
the mine, were soon made wet, as was every thing; which they had occasion to touch. 
Bu' this humid air did not produce the slightest injury to the health of any of them ; 
nor could they discover, after having m: de very particular inquiries, that the workmen 
in this i^nd the other mines w ei e more liable to fevers than persons otherwise employed 
above ground; though it was stated, that pulmonary affections were more frequent 
among them, probably from causes wiiich do not relate to this subject- 



144 

•to assume an aeriform state, at least in any temperature to 
which the atmosphere, or the earth are ever naturally heated ; 
and for this reason, as well as for many others, which are 
sufficiently obvious, it is plain that the noxious effects of 
marsh exhalations, cannot be produced by the mineral sub- 
stances contained in the soil. With regard to the other mat- 
ters, I mean those which belong to the animal or the vegeta- 
ble kingdoms, we know that in suitable circumstances of tem- 
perature, air, and moisture, all organized bodies begin to de- 
compose as soon as the principle of vitality is destroyed, and 
that, in the decomposition of them, a large portion of their 
constituent parts is converted into aeriform fluids of different 
kinds, such as those which are at present known by the nanus 
of nitrogen, hydrogen, carbonic acid, hydro-carbonated, | I 
phorated, sulphurated, and other gazes. It is therefore evi- 
dent, that in a marsh, where myriads of plants and animals 
are constantly perishing, and where the presence of water 
causes them afterwards to undergo a variety of decomposi- 
tions and of new combinations, an abundance of vapours must 
necessarily be disengaged from those decaying substan 
and arise from the surface of the earth, along with the mois- 
ture which is evaporated at the same time. Hence it appears, 
that the atmosphere of marshes must necessarily contain, be- 
sides common air and moisture, a quantity of vapours extri- 
cated from vegetable and animal matters during their decom- 
position ; and since the fevers caused by marsh effluvia do not 
proceed from the action either of pure atmospheric air. or of 
pure moisture, on the human body, it follows, that they can 
only be produced by that of the vapours last mentioned. Se- 
veral ingenious persons have endeavoured to analyze the air 
of marshes; but as their experiments are very Imperfect, and 
the results of them, in some respects, contradictory to each 
other, we are yet without any decisive or satisfactory infor- 
mation on the subject.* When science shall be more ad- 



• Air collected immediately over, anil close upon, the surface of .s com- 

monly been round to contain hydrogen and carbonic acid g^z ■ eoaaidenJrf* proiwiy 



145 

vanced, all the chemical ingredients of marsh exhalations 
may, perhaps, be discovered; hut as most, or all, of the airs 
or gazes hitherto known, have been respired either singly, or 
variously combined, by persons who have submitted to the ex- 
periments of what has been called Pneumatic Medicine, or by 
others engaged in chemical pursuits or manufactures, without 
any of these persons having been attacked by fevers after- 
wards, (although some of those airs have produced other inju- 
rious and even fatal effects ;) it is very possible that the pro- 
perty of causing fever does not belong to any one of those 
gazes in particular, but rather to several of them collectively, 
or, perhaps to some peculiar miasm emitted at the same time 
with the gazes, which it may be as impossible to detect by any 
tests, however ingenious, as it is to detect the contagions of 
the small-pox, measles, typhus fever, &c. when existing in the 
common air. We may never even discover whether the va- 
pours of marshes derive their property of causing fever from 

tions, with a great deficiency of oxygen gaz. That this should he the case might well 
he expected, considering what the constituent parts of vegetables and of water are, so 
far as we have been able to discover them, and how they must naturally act upon each 
other, when undergoing spontaneous decomposition. Animals are supposed to consist 
of principles similar to those of vegetables, with the addition of nitrogen, (or azote) 
and of sulphur and phosplwrus, in different states. A few, indeed, of the vegetables 
are composed of nearly the same matters as animals. Ammonia, of which nitrogen is 
a constituent part, has been supposed, particularly by Van Mobs, to have the property 
of correcting or meliorating air, when it abounds with carbonic acid gaz. If this sup- 
position be well founded, will it enable us to understand why the vapour of animal mat- 
ters only, when they are decomposing or putrefying, does not excite fever in mankind 
as that of vegetables appears to do ? 

Dr. William Carrie, of Philadelphia, seems to believe, " that the unwholcso—.em ss 
of low and moist situations in the summer and autumnal months is not owing to any 
invisible miasmata, or noxious effluvia, which issue from the soil, aad lurk n. the air, 
but to a deficiency of the oxygenous portion of the atmosphere in such ''tuitions, in 
consequence of vegetable and animal putrefaction, in conjunction with the exhausting 
and debilitating heat of the days, and the sedative power of the cold air' damn air of 
the night." (American Philosophical Transactions, vol. iv. p. 128.) But if the mere 
abstraction of a part of the ordinary proportion of oxygen in the atmosphere could oc- 
casion imermittents or remittents, these fevers ought to be produced by every crowded 
assembly, and in a multitude of situations, witere no such effect has been observed or 
suspected. 

19 



146 

vegetable matters alone, or from animal, or from the mixture 
of both: indeed, the discovery, could it be made, might prove 
of little utility towards explaining the effects of marsh exha- 
lations ; but at present it seems probable that this property 
is derived from vegetable matters exclusively ; because some 
decomposing plants, particularly hemp and flax, during their 
preparation by steeping in water, and the indigo plant laid in 
heaps (after the colour has been extracted) to form manure, 
have often been accused, and in several instances with great 
apparent justice, of occasioning dangerous fevers among per- 
sons living near them ;# while, in regard to animal matters, 

* Some difference of opinion Las formerly existed among medical writers, concern- 
ing the morbid effects produced by the steeping and partial decomposition of hemp 
and flax to fit them for subsequent operations. Lancisi, however, after having consi- 
dered all the known facts respecting this question, thinks them easily reconcil 
admitting that this operat ion is harmless, if performed in streams of ruwiiv^ 
(" •lihil ohessc liui mr.ceratione in aquis flucntibus ;"_) but noxious in stagnant shallow 
water, and confined situations ; (" contra vero ejusmodi macerationem ftestilentem esse 
constat, ubi palustres desident aquae, ventique silent ;"") and he gives the history of an 
epidemic fever, comn. only intermittent or remittent, and often resembling the terti- 
ana lethargies of 'I'orti, which, for several summers, infested and almost depopulat- 
ed the ancient town of Urbs Vetus, in an elevated and salubrious part of ttruria; and 
which was occasioned by ponds or stagnant waters, in the lower part of the town, m 
which hemp and flax were macerated 5 (in quibus linui.i ' .cerabantur") 

but this being prohibited in 1705, the fevers did not afterward* recur. See Laneisius 
de noxiis paludum eili nils, pages 32, 942, and $$4. I was also informed at Naples, 
that in several places near that city, anil particularly in some beyond the tirottoof 
Posilippo, the sleeping in hou. es contiguous to ditches, in which hemp or Cax were 
steeping, had been almost constantly followed by fever- 

Equally injurious effects have been ascribed to the preparation of indigo, both in die 
Past and West I dies, by several w r i ter s; and, according to the best information, 
which 1 have obtained on the subject from veil-informed gentlemen, vho had been 
largely concerned in the manufacture of that article, these are chief _ xcasioned by 
the exhalations, arising from vast heaps of the indigo plant, \\hic v are Begl 
formed (after the colouring principle has been extracted) near Lhi i Itouscs 

of the labourers, and there left to decompose and become manure which is of an ex- 
cellent quality after two or three years. These heaps, welte<l I rom lime to time bj 
heavy rains, and afterwards heated by the powerful rays of a vertical sun, em 
copiously, vapors, or miasmata, resembling in their effects those of ruarsl.es, tor those 
persons \\ ho live near to, and esi>ecially on the leeward side of, thes^- feimei 
getable masses, a e eommonh attacked by fivers, chiefly remittents, and similar to 
those which prevail in swampy siuiauons. And, according to my information, the 



147 

numerous facts already mentioned, seem to prove that, how- 
ever putrid they may become, their effluvia do not excite fever 
of any kind ; and, in regard to the mixture of putrefying ani- 
mal and vegetable matters, we have daily proofs that vapours 
may arise from them, for example, from large dunghills, 
without sensibly affecting the health of people who live close 
to them, or who are enveloped for hours together in their 
fumes, while working upon them. 

As it appears, from these observations, that the noxious in- 
gredients existing in marsh vapours can only be yielded by 
vegetable or animal* matters during their decomposition; 
this conclusion leads us .naturally to suppose, that the marshes 
best adapted to emit powerful miasmata must be those in 
which the proportion of vegetable or animal substances is 
greatest, and in which their decomposition will be the most 
rapid and complete. The circumstances, therefore, which fa- 
vour such decomposition, deserve particular notice, as fa- 
vouring the production of miasmata in an equal degree. 

Animal and vegetable substances require for their sponta- 
neous decomposition, moisture, the contact of air, and cer- 
tain degrees of warmth. With regard to the first of these 
agents, (moisture) it is so necessary, that there is nothing 
more efficacious in preventing such substances from putrefy- 
ing, even for centuries, than the total deprivation of it. It 
may, therefore, be affirmed, that moisture is essential to 

connexion of these fevers with the heaps of fermenting indigo plants is now so well 
understood and believed in that part of the world, that the more intelligent indigo- 
makers no longer permit such heaps to be formed near their works, or the habitations 
of thek* workmen, but cause them to be placed at considerable distances, and to 
the leeward thereof, and thus preserve their labourers in health. 

* In this and other places I mention animal substances as concurring with the vege- 
table in producing marsh miasmata, because there are, probably no grounds whence 
these miasmata arise, which do not contain some dead insects and reptiles, with other 
animal matters ; and I cannot venture to assert, that these have no share in producing 
the morbid exhalations in question ; though, for the lately-given reasons, I am disposed 
to believe, that they are wholly formed by the mutual decompositions of vegetables and 
of water ; and that animal matters, when in considerable proportions, may even have 
an opposite, or correcting eftect. 



148 

putrefaction, and, consequently, that no miasmata can be 
formed, in a soil which is perfectly dry. Accordingly, it is 
found on the west coast of Africa, and in some of the West 
Indian islands, which are liable to long droughts, as Barba- 
does, and more particularly Antigua, that marsh fevers occur 
very seldom in those dry seasons; but that they become very 
prevalent whenever these droughts are suddenly terminated by 
frequent rains. But neither will putrefaction take place 
without the presence of air, moisture alone being insufficient 
for that process; thus substances, which would have been 
readily decomposed in the open air, have been preserved un- 
corrupted for ages, while immersed in water, and thereby, in 
a great degree, secluded, from the air; for although it be true 
that air or oxygen exists naturally in water, yet it exists in a 
quantity which is often too small for any, but «ery slow, pu- 
trefaction, at least in certain substances. 

Examples of this fact are not, indeed, frequent with ani- 
mals, probably because they naturally contain more air. and 
therefore require less for their decomposition than vegetable : 
but it is very certain, that many kinds of timber ha\< 
mained under water for a great lapse of tune in a perfectly 
sound state. Rence we may perceive, also, that the forma- 
tion of miasmata, instead of being assisted, v. ill be greatly 
impeded by a superfluity of wa riding and separating 

the matters to be decomposed, and obstructing the acci 
air to them) and that it will be most abundant in thai 
which contains no more moisture than is really necessary for a 
complete decomposition of the vegetable and animal ma 
existing therein. An attention to this important truth will 
enable us to understand why, in some countries, frequent and 
heavy rains render marsh fevers prevalent, while in ott 
the deprivation of rain for two or three months produces 
equally morbid effects. Dr. Lind was fully convinced of 
these similar results from such seemingly opposite causes in 
different countries; and. at page 43 of his volume on preserv- 
ing the Health of Europeans in Hot Climates, ^5th edition) he 



149 

appears to have thought it difficult to assign satisfactory rea- 
sons for them. What I have just mentioned respecting the 
Western Coast of Africa and the Islands of Barbadoes, An- 
tigua, &c. will serve to illustrate and prove the morbid effect 
of much rain in dry situations ; and for instances of equally 
morbid consequences in opposite situations, from the want of 
rain, we need only refer to certain countries between the tro- 
pics, which being naturally very low, are mostly overflown 
during the rainy seasons, in which their inhabitants are com- 
monly healthy ; fevers being rarely seen among them until 
the prevalence of dry weather has so far caused the water to 
evaporate from the ground as to leave the surface uncovered 
in many places. This notoriously happens in the Dutch and 
French Colonies on the Coast of Guiana ; I mean Surinam, 
Berbice, Demerary, and Essequebo, as well as at Cayenne, 
and the adjoining settlements on the Continent, where marsh 
fevers only prevail in tiie latter part of the dry seasons. The 
like causes produce or augment the noxious influence of marsh 
miasmata at Fort Royal, and its neighbourhood in Martini- 
co ; and, to use the words of Dr. Gillespie, " with greater 
effect when the rivers are low by the continuance of dry wea- 
ther, and when the tides, which never rise more than one 
foot, are weak. — This," he adds, " seems to account for the 
generation of remittent and intermittent fevers more power- 
fully in dry than in wet weather, as is the case here." Ob- 
servations on Diseases, &c. on the Leeward Island Station, 
&c. p. 24. Dr. James Clarke also, when treating cf the 
bilious remittent fever in Dominica, observes, that " when 
there was much rain in the months of May and June, and dry 
sultry weather prevailed in the following months of July and 
August, this fever raged much among the troops and stran- 
gers." Treatise on the Yellow Fever, &e. p. 75. 

This is also the case in a great part of St. Domingo, as has 
been observed both by French and British writers. Among 
the former, M. Gilbert, who was chief physician (medecinen 
chef) to the army sent, in 1802, under General Le Clerc, to 



150 

reduce that island, ascribes the aggravated violence and pre- 
valence of the yellow and other marsh fevers, which, in a 
few months, nearly destroyed that army, to "les effets d'une 
secheresse extraordinaire, et d'une chaleur devorante." See 
p. 4 of his " Histoire Medicale de PArmee Francoise a St. 
Dominance." He afterwards refers, at p. 69, to the work of 
M. Poup^e Desportes, who died at St. Domingo in 1748, 
and who, after having attentively observed the Yellow Fover 
in that island for fourteen years, found " qu'elle a ete tou- 
jours d'autant plus cruelle, que les annees out trte plus seencs." 

Baglivi informs us, (Opera Omnia, p. 157, 15S,) that the 
marsh fevers, arising from damp situations in and about 
Rome, were greatly aggravated by the like causes : and he, 
therefore, adds * minim non videatur si consulibus L. Vale- 
rio Potito & M. Manlio, Pestilentia orta sit in agro Romano, 
ob siccitates <$* nimios solis calores, teste Livio, Lib. V.*' 
That which Livy here , and in some other places, has denomi- 
nated Pestilence, was, probably, no other than a violent epi- 
demic al marsh fever, differing, perhaps, a little in degree 
(only) from what is now called Yellow fever. 

These facts suggest, and enable us to understand, the ex- 
pediency of sometimes inundating a marsh, during the heat of 
summer, when its exhalations prove noxious to the inhabitants 
of a neighbouring town ; it having been always found, that so 
long as marshes are completely overflowed, the vapours aris- 
ing therefrom are innoxious, and that they only become inju- 
rious when so much of the water has been evaporated as to 
expose the surface of the soil to the air.* For these reasons 



* Of this Sir John Pvingle gives a decisive proof, at p. 62 of his Observations on t!»e 
Diseases of the Army, 7th Edit. viz. The country round Breda had been inundated at 
tl..- commencement of the war, for military purposes; but early in the summer of 174S, 
the preliminaries of peace having been signed, the water was let oft", and the grounds, 
which had been cover d by it, were, by this operation, made bare and es 
sun's rays, so that " a dangerous epidemic fever, of the remittent kind," soon " raged 
at Breda and the neighbouring villages. The St'tes of Holland, being made sensi 
this, gave oixlers to let in the water again, and keep it up till winter. "' An expedient 
which produced the desired effect, as it has done on other similar occasions. 



151 

tt appears very probable that any piece of ground, in a hot 
climate, which contains a portion of fresh, or undecomposed, 
vegetable matters, and which, by being low and flat, with a 
suitable substratum, or intermixture of clay, is adapted to 
the retention of moisture, would, if supplied with only a mo- 
derate quantity of water, be soon in fit condition for emit- 
ting* Aery concentrated miasmata ; and it seems very proba- 
ble, also, not only that the quantity of water necessary for 
this effect might not be sufficient to convert the ground into 
what is commonly called a marsh, but that it might even be 
so small as to escape common observation.* 

Here, however, it is necessary to observe, that, under 
some circumstances, the earth may contain very large quan- 
tities of vegetable matters, and an abundance of moisture, 
and yet not be in a state to give out vapours capable of caus- 
ing fever, although the temperature should be such as to per- 
mit the formation of them. — This is the case with peat-bogs 
or moors, the inhabitants of which, as I have before remark- 
ed, are exempt from those intermittent fevers, which are so 
frequent over marshy districts. — These bogs possess, in a re- 
markable degree, the power of preserving substances from 
putrefying, it being well ascertained, that not only plants 
and trees, but even human bodies with their clothing, when 
completely immersed in the peat-soil, will scarcely undergo 
any change during a long course of years ; and it is proba- 
bly owing to this peculiar property that they do not exhale, 
and, perhaps, do not generate, miasmata similar to those 
which arise from marshes. — For proofs of this exemption of 
the inhabitants of peat-bogs from intermitting fevers,, see Ap* 
pendix, No. 6. 

* Dr. M'Lean, in his volume on «' The Diseases of the Army in St Domingo," at 
page 25, says, " It must he admitted, thiit fatal miasmata arise where there are no 
very certain appearances of a marshy soil. The Mole and St, Marks, (St. Domingo) 
do not appear surrounded with marshes, and yet the fever reigns in both these places 
with great activity." 



[52 

Some chemists, who have made experiments with a view to 
discover the nature of peat, are of opinion, that its antisep- 
tic powers are derived from that vegetable principle to which 
the name of Tannin has been recently given. It appears, 
however, that a certain proportion of iron is always found in 
peat ; and as this metal, when either dissolved or oxydated, 
is capable both of preventing putrefaction and of tanning, op 
converting skins into leather, (a fact not generally known at 
present) there is room to suspect that chemists may have at- 
tributed to that imperfectly-understood principle, tannin, those 
properties which, in reality, belong to the oxide of iron 
alone.* 

Heat is the last of the agents requisite to the formation of 
miasmata, which we are to notice. Putrefaction, it is known, 
is wholly suspended in a freezing temperature, and proceeds 
very slowly, while the mercury in Fahrenheit's thermometer 
continues below 45°; but, in proportion as the mercury rises 
above this degree, putrefaction takes place more readily, and 
proceeds with greater activity, being most rapid and complete 
in a temperature of about 100°; every addition of heat, how- 
ever, beyond 100°, seems to check that process. 

Hence we perceive how much more copiously the miasmata 
given out by vegetable and animal substances during their de- 
composition must arise from marshy grounds in hot than in 
cool weather ; moreover, a warm temperature is suited, in a 
remarkable degree, to the growth and multiplication of plants 
and animals — and thus it yields a plentiful supply of materials 
from which miasmata are formed ; it is not surprising, there- 
fore, that we should uniformly find the exhalations of marshes 
to be most powerful when the seasons are hottest, or that the 



* I ought here to observe, that the antiseptic power of these bogs, (whatever it laav 
be) is not sufficient to preserve animal and vegetable matters from decomposition, in a 
very high temperature ; and it is, perhaps, for this reason that peat-bogs, although fre- 
quent in countries in which the summer is warm enough for the production of intermit- 
tents, are not known to exist between the tropics, unless, perhaps, in the more i 
ed parts of Quito and Peru, where the heat is less than in. France and Spain. 



153 

Tiolence of marsh fevers should always correspond with the 
heat of the atmosphere at, or some time previous to, their oc- 
currence. Where the surface of the earth remains frozen 
for a considerahle space, as, during the long winters of north- 
ern countries, these exhalations have no existence, and marsh 
fevers never occur, unless it be from miasmata, generated and 
imbibed during the preceding summer and autumn. They 
begin, however, to make their appearance soon after the re- 
turn of spring, but at first only in their mildest and most in- 
nocent form ; that is, as regular intermittents, generally of 
the tertian type ; and they preserve this type while the tem- 
perature continues to be moderate. Afterwards, when the 
weather becomes warmer, these fevers become less regular 
and more severe : and, in the hottest parts of the summer or 
autumn, they frequently assume the more aggravated types of 
double tertians, or of remittents. In this country, however, 
where the summer is but moderately hot, the last-mentioned 
types of marsh fever are not usually of a dangerous charac- 
ter ; but in Holland, the Netherlands, Germany, &c. where 
the heats of summer are generally greater than in this cli- 
mate, marsh fevers are often attended with considerable mor- 
tality, as may be seen in the able account which Sir John 
Pringle has given of them in his work on the Diseases of the 
Army; and as was recently experienced in the unfortunate 
expedition to Zealand. 

In the still hotter summers or autumns of Spain, Italy, and 
more southern regions, these remittents are yet more violent,* 

* " Principio aestatis febres, ut plurimum tertians, non maligna, corripiunt: adaucto 
vero sstu, t'ebres continue, atque etiam exitiales urgent ; longe tamen deteriores eva- 
surae, et plane pestilentes circa sequinoctium antumnale, prsecipue si pluvise, nebula?, 
rubigines, ventique australes accesserint. Tandem circa byemale solstitium de perni- 
cie ubique remittunt, &c." Lancisi de noxiis pallidum effluviis, pag 42. 

"The epidemic of autumn, and prevailing distemper of this, (Zealand, Brabant, and 
Flanders) and other marshy countries, is a fever of an intermitting nature, commonly 
of a tertian form, but of a bad kind, which, in the dampest places and worst seasons, ap- 
pears as a double tertian, a remitting, or even an ardent fever. But however these 
fevers may vary in their appearance, according to the difference of constitutions and 

20 



154 

and, as will hereafter be shown, they very frequently appear 
in the form which is known at present by the name of yellow 
fever* the most fatal examples of which may commonly be 
found in the hottest parts of the globe, when other circum- 
stances are favourable to the production of marsh miasmata. 
Experience, therefore, warrants us to conclude, that in cool 
temperatures, none but the milder types of these fevers are 
ever produced, and (as will be abundantly proved hereafter,) 
that it is only in the hotter, that they occur in their most ag- 
gravated and violent forms: and although a considerable 
share of their increased severity should, as I think, be as- 
cribed to the direct operation of heat upon the human body, 
a greater ought, 1 presume, to be imputed to its powerful 
chemical agency, in promoting the formation of marsh mias- 
mata, more copiously, and probably with greater morbific 
powers. 

I ought here to notice the well-known influence of clay, in 
promoting the formation of marsh miasmata, either as a stra- 
tum for the soil, in which they are formed, or when mixed 
with it in a large proportion. The celebrated Linnaeus, who, 
in the early part of his life had travelled over nearly the whole 
kingdom of Sweden, found, or thought he had found, that in- 
termitting fevers occurred in all those places, where the soil 
abounded with clay, and only in such places. Strongly im- 
pressed with this fact, he was led by it to imagine and be- 
lieve, not that clay contributed to the production of marsh 
miasmata, by retaining the water necessary for the decompo- 
sition of organized matters, (as is probably the case) but that 
the particles of clay being dissolved in the water, drank by 
the inhabitants of these places, were conveyed into the blood 
vessels, and there occasioned fevers, by creating obstructions ; 
according to the Boerhaavian doctrine, then prevalent. In 



other circumstances, they are all of a similar nature. For, though in the beginning of 
the epidemic, when the heat is greatest, they assume a continued, or a remitting- form, 
yet, by the end of autumn, they usually terminate in regular interraittents." Pringle, 
Observations on the Diseases of the Army, p. 6. 



155 

this belief, he published bis " Hypothesis nova de febrium in- 
termittentium causa;" as an inaugural dissertation for the 
degree of Doctor in Physic, which he took at a later time of 
his life than was usual. In this dissertation he mentions the 
•* loca natalia" or places in which he had found intermittents 
to exist ; and the different degrees of force and frequency in 
which they occurred, and also those in which these fevers 
were wholly or almost unknown. By this account they ap 
pear to have been prevalent in the Southern and Eastern pro- 
vinces of Sweden, but not in the Northern, where, with a very 
few exceptions, they had never been seen ; a circumstance 
which might naturally have led him to take into his conside- 
ration the effects of temperature in contributing to their pro- 
duction. Attending, however, only to the supposed co-eotis- 
tence of clayey soils, and intermittents, (which a Swedish 
clergyman, at Philadelphia, had represented as being a fact, 
in that part of America also,) Linnfeus delivered his new hy- 
pothesis in these words, "Nostra igitur est sententia quod 
intime solutse particulse argillacese, quae lubricae sunt, cum 
aqua simul potse et cibo mixtse, sanguinem intrent et tandem 
ultimis vasis arteriosis resideant, & morbi symptomata cre- 
ent." In the truth of this hypothesis he was so confident as 
to advance this assertion, " Vana tamen est omnis cura, ni 
caveatur simul a causa data, scilicet aqua argillacea, quod ex- 
perientia toties comprobavit." Linnsei Amsenitales Academ, 
Vol. I. 

Besides the greater or lesser aptitude of particular soils to 
retain the portions of moisture best suited to tlie decomposi- 
tion of organized matters, some differences, both in the quan- 
tities and qualities of miasmata generated therein, will pro- 
bably result from the particular vegetable and animal sub- 
stances dispersed in them, and from their relative propor- 
tions to each other. Lancisi " De noxiis Palud." &c. p. 44, 
supposes the marsh effluvia of particular places to differ from 
each other, as well in their nature as effects — and Sir John 
Pringle asserts, " that the putrefaction of animal or vegeta- 



156 



ble substances, in a dry air, is apt to produce a bad fever of a 
more continued form ; whereas putrid effluvia, in a moist at- 
mosphere, have a greater tendency to bring on paroxysms 
and remissions." (Diseases of the Army, p. 324, 7th edit.) 
Probably, however, this distinction, if it has any foundation, 
must principally depend on a greater concentration of the mi- 
asmata extncated in a dry air, than of those which have been 
diluted and diffused by the redundant aqueous particles which 
necessarily accompany great moisture. Whether this greater 
or lesser concentration constitutes the whole difference be- 
tween the morbid exhalations of particular places and season 
is a question which I am afraid to answer, because the known 
facts connected with it are too few to warrant a decision. It 
is, indeed, probable, as will hereafter be mentioned, that the 
miasmata of particular towns, (mostly either sea-ports or ac- 
cessible to shipping) in which the aggravated forms of yellow 
fever have almost exclusively prevailed in the W est Indies, 
the United States of America, and the southern parts of Eu- 
rope, differ from the common exhalations of marshes, in 
quality as well as in degrees of concentration ; but whether 
this difference be occasioned merely by the greater heat which, 
at such times, commonly exists in these towns than in the sur- 
rounding country, and which may exalt the powers of such 
miasmata, by perfecting the decompositions which produce 
them, or whether it be partly the result of a difference in the 
organized matters decomposed by that excessive temperature, 
I am unable to determine. 

But, besides the influence of rain in the formation of mias- 
mata, it seems to assist afterwards in promoting their ejctrica- 
tvon from the soil, and their diffusion in the atmosphere. Dr. 
Blane, (p. 261 of his Observations on the Diseases of Seamen.) 
considers moist air as " a vehicle of noxious exhalations, with 
which (says he,) it seems to have a greater chemical affinity 
than dry air." This is, at least, true of carbonic acid gaz, 
which is, doubtless, one ingredient of these exhalations. 
There are, moreover, some countries, in which rains mav 






157 

promote the extrication of miasmata without any chemical at- 
traction, merely by loosening and opening the surface of the 
earth, which, particularly on the coast of Africa, is often 
overspread by a hard crust in the dry seasons. Dr. Lind, in 
his work on the Diseases of Europeans in Hot Climates, 
states this fact (p. 47,) adding, that, " by the continuance of 
rains this crust is softened, and the long pent-up vapours are 
set free, which thence become the cause of sickness." 

Dr. Henry Warren, also, seems to have observed the effect 
of rain in assisting the extrication of marsh miasmata, but 
without suspecting the mode of its operation, which indeed he 
was not likely to do, because he believed the yellow, or, as 
he called it, malignant fever, of Barbadoes, to arise solely 
from contagion. He states, however, at p. 8 of his Treatise, 
and, as he thinks, " with great certainty, that, at the time 
this malignity is actually harboured among us, (i. e. in Bar- 
badoes) a continuation of dry and sultry weather has been so 
far from giving any aggravation to it, that it has rather 
seemed to repress it, and make it lie more lulled and dor- 
mant, until the returning rains, and a moist atmosphere, had 
set it at liberty to exert its rage." It is difficult to conceive 
how rain could hav& produced such an effect, if the disease 
had been propagated, as Dr. Warren supposed, by personal 
contagion ; and therefore his statement of a fact, at variance 
with his theory, is the more to be depended upon, because it 
must have clearly manifested itself to his senses ; and it will 
serve to confirm what I lately mentioned at p. 198 of the sa- 
lubrity of the air at Barbadoes during the continuance of hot 
and dry weather. 

It has been frequently observed by others, as well as my- 
self, that the prevalence of cold easterly winds, in the spring, 
has been soon followed by that of intermittents in persons 
who had been exposed to marsh effluvia. Dr. Lind, at p. 16 
of Ids volume on the Diseases of Hot Climates, mentions 
this to have happened in a very extraordinary degree, in the 
years 1763 and 1766 ; and he appears to think that an easter- 



158 



ly wind has some peculiar aptitude for extricating or absorb- 
ing marsh miasmata, or, to use his own words, that it 
(i raises a copious vapour from water mud, and all marshy, 
or damp places." I am, however, disposed to believe, for 
reasons to be hereafter mentioned, that, in this case, the east 
winds act merely as an exciting cause upon persons who had 
imbibed marsh miasmata during the preceding summer and 
autumn, and which had remained inactive during the winter. 

From this general view of the sources of marsh effluvia, 
and of the circumstances which are requisite or favourable to 
their production and extrication, it will be perceived tbat the 
former depend entirely on the joint influence of seasons, and 
of local circumstances: — The seasons, indeed, vary so much, 
as rarely, if ever, to resemble each other exactly in the course 
of many years, and are sometimes in one year the very re- 
verse of what they were the year before at the same places : 
thus of the two winters of 1794-5, and of 1795-6; the for- 
mer, says Dr. Heberden, in his paper on the influence of 
cold upon health, (in the philosophical transactions for 1796) 
was " the coldest, and the latter the warmest, of which any 
regular account has ever been kept in this country." We 
may conclude, therefore, that considerable variations, with 
regard to the formation of miasmata, must annually occur in 
every place ; and we ought to find, not that the health of per- 
sons living in or near a swampy or low situation is affected 
in the same manner every summer or autumn, but, on the 
contrary, that it is very differently affected in different years, 
as it is known in reality to be, by all medical practitioners in 
marshy countries. 

Thus it was observed many years ago by Dr. Chalinei-. 
who practised medicine with great reputation for a long time 
at Charleston, in South Carolina, and paid very minute at- 
tention to the climate, that the yellow or putrid bilious fevei 
appeared in that city whenever "the weather was very warm 



159 

and wet withal."* This, he states to have happened in the 
year 1770, when " much rain having fallen throughout the 
summer," and the weather becoming " so warm that the 
mercury often rose to the 96th degree of the thermometer, the 
putrid bilious fever appeared in August, and continued till 
the month of October following."! The same observation 
has repeatedly been made, before and since his time, concern- 
ing the effects of a very hot and moist season on the health of 
the inhabitants of Charleston,! and when we recollect that the 
city itself is placed on a low fiat point of land, between two ri- 
vers, upon which great encroachments have been made by 
wooden wharves, &c. and that the adjoining country is, also, 
very low, and in many parts swampy, we shall readily per- 
ceive, that a season like this must have been extremely favoura- 
ble to the formation of miasmata in that situation. But a very 
different effect resulted from the very hot summer of 1752, 
described by the same author, vol. 1, p. 22, and in which 
" : the mercury often rose above the 90th degree throughout 
the months of May, June, July, and August ; and, for twen- 
ty successive days, excepting three in June and July, the tem- 
perature of the shaded air varied between the 90th and the 
100th degree ; and sometimes it must have been 30 warmer 
in the open sunshine, to which great numbers of people were 
daily exposed for many hours together." — When the mercury 
iose to the 97th and 98th in the shade, the atmosphere seemed 

* The ground, upon which the city of Charleston is built, though very low, contains 
k large proportion of sand, and more frequent falls of rain are, therefore, necessary for 
the production of marsh effluvia therein, than would otherwise contribute to that effect. 

■\ See his account of the Weather, and Diseases of South Carolina, vol. 1, p. 163. 

± Dr. Moultrie, of Charleston, in South Carolina, in his valuable " Dissertatio inaug- 
urate de febre maligna biliosa Americse," printed in 1749, mentions it as having been 
there observed, " Quo calidior est cceli temperies, eo vehementiusfebris maligna bilio- 
sa grassatur" And in confirmation of this observation he adduces the following in- 
stance, viz. " Anno 1748, in eodem loco (Caroli oppido) febris hsec erupit circa 
medium mensis ^ugusti, prima cujus septimana nulla ibi unquam calidior erat, ut mer- 
curius in Fahrenhetii thermometro ad 97°, 97 1-2 et 98 in aere umbroso ascenderet, et 
calor hicce cum multis imbribus diu duravit : a cceli temperie in frigidiorem versa 
mitestit t etini?itermittentemfebrimmutabatvr." Page 8. 



160 

in a glow, as if fires were kindled around us : in breathing, the 
air felt as if it had passed through fire ; nor were the nights 
much less sultry and distressing than the days ; refreshing 
sleep, therefore, was a stranger to our eyes, insomuch that 
people were, in a manner, worn down with watching, and the 
excessive heat together." It is not, I believe, easy to con- 
ceive that any state of the body could have been more favour- 
able to the occurrence of the yellow fever than the above ; 
yet, says Dr. Chalmers, " a more healthy season had never 
been known than this, so long as the weather continued stea- 
dily warm and fair." The cause of this singular healthiness 
is, however, easily explained : for during this time, as ap- 
pears from another part of his work, (i. e. p. 18 and 19 
" a general drought prevailed.' 9 " The earth was so parched 
and dry that not the least perspiration appeared on plants, 
which shrunk and withered ; all standing waters were dried 
up, so that travellers could not find water for themselves or 
their beasts for a whole day together :" * in several settle- 
ments no water could be found by digging ever so deep.'- 
While the earth was so completely exhausted of moisture it 
is obvious that no miasmata would be formed in it.* 

Having offered these examples of the opposite effects, which 
two different seasons have actually produced in the same place 
it would be superfluous to enter upon a detail of the divers 
consequences which may result from other varieties of season. 
Nor is it necessary to present a statement of particular facts 



* Dr. John Hunter, in his Observations on the Diseases, &c of Jamaica, observes, 
at p. 13, that " the heat of tropical climates, though generally reputed the cause of 
their unhealthiness, will not alone produce fevers, as is strongly exemplified in those 
living on board of ship, who remain free from fevers ; and, also, in the inhabitants of 
certain dry sandy spots, along the coast, in which the heat is uncommonly great, yet 
the situations are healthy, as Fort Augusta, Port Royal, and others." 

In Egypt, when the British army, at the siege of Alexandria, in the summer of 1801, 
was encamped on dry sand, at a distance from all swamps, with the sea on < ne skle 
and the Lake Maadie on the other, a fever was rarely, ifewr, seen. I observed a 
similar exemption from fever in the same season at Rosetta, which is at some distance 
from any swamp. 



161 

to shew that the differences of local circumstances are neither 
less numerous nor less important, towards the generation of 
noxious exhalations than those of season. It may, therefore, 
be affirmed, that as the inhabitants of any one place cannot be 
affected in the same manner in regard to health every sum- 
mer, or every autumn, so likewise they may he very different- 
ly affected, in the same season, from the inhabitants of another 
place situated within a short distance from themselves. Thus 
it seems perfectly consistent with the laws of nature that the* 
summer of 1800, which produced the epidemic yellow fever in 
Cadiz and Malaga, should not have been able to produce it at 
Gibraltar; and that the summer of 1804 should have been 
such as to occasion the disease in each of these towns. In an- 
other part of this volume I shall endeavour to shew that the 
above variety in the occurrence of the disorder at those pla- 
ces may justly be ascribed to situation ; and will therefore, ab- 
stain from any further observations at this time on the influ- 
ence, which mere locality possesses over health, under differ- 
ent circumstances of weather. 

The distance to which the exhalations of marshy grounds 
may be conveyed from their source, and retain the power of 
causing the yellow or other marsh fevers, will partly depend 
on the force of the wind, and partly on the extent of the sur- 
face from which they arise, and on their being more or less 
copiously extricated from that surface. If the wind be very 
moderate, and blow steadily from the same point, and if the 
miasmata be abundantly emitted from a very great extent of 
surface, it seems probable that so large a mass of them as 
would thus be formed might be conveyed a quarter, and per- 
haps half a mile, before it became so diluted with atmospheric 
air, or so dissipated by the wind, as to lose its morbific power : 
and, it is obvious that such a mass of exhalations, if it were 
wafted into a town, would be able to produce fever in the ma- 
jority of the people inhabiting the quarters which it traversed, 
with as much ease as it would produce fever in an individual 

21 



162 

only ; or, in other words, that it would within a certain ex- 
tent, as easily cause an epidemic as a sporadic fever. 

In mentioning " a quarter, and perhaps half of a mile," as 
the greatest distance at which marsh effluvia seem capable of 
being conveyed, even under the most favourable circumstan- 
ces, from their source, so as to produce disease. I have con- 
lined their morbid influence within much narrower limits than 
those which are generally described by medical writers ; most 
of whom suppose marshes capable of exciting fever at the dis- 
tance of several miles. It is, indeed, to be regretted, that ob- 
servations on this subject, have not been made, and reported 
with greater care and precision. Sir John Pringle, indeed 
appears to have thought more justly on this subject, and after 
describing the epidemic marsh fever which raged in Zealand, 
both among the inhabitants and the British troops, in the year 
1747, he adds, " But Commodore Mitchell's squadron, which 
lay all this time, at anchor, in the channel between South 
Beveland and the island of Walcheren, at both which places 
the epidemic prevailed, was neither afflicted with the fever 
nor the flux; but amidst all that sickness enjoyed perfect 
health." (Diseases of the Army, p. 57.) This immunity of 
the British seamen is, by the author, justly ascribed to their 
having been out of the reach of that which he calls M the moist 
and putrid air of the marshes,*- though the whole width of the 
channel is, I believe, in general, but little more than one mile 
and therefore the squadron could not, even at midway, be pla- 
ced at more than half that distance from the grounds whence 
noxious miasmata arose. Dr. Lind (on preserving the 
Health of Seamen, p. 69) notices this fact, and makes the fol- 
lowing addition to it, viz. " when Commodore Long's squad- 
ron, in the months of July and August, 1744, lay off the mouth 
of the Tiber, it was observed that one or two of the ships. 
which lay closest to the shore, began to be affected by the perni- 
cious vapour from the land, whilst some others, lying further 
out at sea, at but a very small distance from the former, had 
not a man sick; at the same time, the Austrian army, under the 



163 

command of Prince Lobcowitz, suffered so great a sickness, 
through the proximity of their situation to the marshy coun- 
try, that they were obliged to decamp." 

Dr. Blane, also, observes, that " it is difficult to ascertain 
how far the influence of vapours from wood and marshes ex- 
tends, but there is reason to think that it is to a very small 
distance. When ships watered at Rockfort, (Jamaica) they 
found that if they anchored close to the shore, so as to smell 
the land air, the health of the men was affected, but uppn re- 
moving two cables' length, no inconvenience was perceived." 
(Diseases of Seamen, p. 206.) 

But the most decisive evidence on this subject has been ob- 
tained by the late expedition to Zealand. Drs. Blane, Lem- 
priere, &c. in their report to the Secretary at War, dated 
Middleburg, October 10, 1809, and printed by order of the 
House of Commons, assert their " having ascertained that 
the crews of the vessels stationed in the very narrow channel 
(only a few yards* from the land) between Beveland and 
Walcheren, have continued perfectly healthy the whole cam- 
paign ; thus decidedly proving that the noxious exhalation is 
nearly confined to its original source." Here it should be 
recollected, that it is stated in the same report, that " the 
number of sick and convalescents, in the different hospitals, 
amounted to more than two-thirds of the total force," at that 



• This expression of " a few yards" is much too indefinite. In conversing on the 
subject afterwards with Dr. Blane, he appeared only to be certain that the vessels in 
question, or, at least, many of them, were stationed at less than a quarter of a mile 
from the shore. According to the best information which I have been able to obtain, 
the ships of war at Flushing were anchored generally at about one quarter of a mile 
from the shore. Those in the ttoompot channel at about three-fourths of a mile from 
land. It was chiefly in the latter channel, and at about that distance from shore, that 
the transports having on board the cavalry, (viz. 2d Dragoon Guards, and 9th and 12th 
Light Dragoons) were stationed. These did not land, and, consequently, did not 
partake of the sickness. Mr. Webb, Inspector of Hospitals, in his evidence at the 
House of Commons, asserts, that " the men who remained on board the ships were 
extremely healthy." 



164 

time, " notwithstanding about 1500 sick had been already 
sent home by different conveyances from Walcheren alone." 

The general prevalence of heaUh on board the ships of war 
and transports was also confirmed, on my enquiry at the 
Transport Office, by Mr. M'Leay, Secretary, and Mr. 
Houseman, chief clerk of that department. Dr. Blane, also, 
had the goodness to communicate to me a letter from Captain 
Hanchett, who commanded the Raven Sloop of War, during 
the expedition against Zealand, and being wounded, had re- 
mained thirteen nights on shore, (for the cure of his wounds) 
by which he contracted an obstinate intermittent. In his let- 
ter, dated Exeter, April 29th, 1801, Captain Hanchett writes 
as follows : " the Raven, while I commanded her on the late 
expedition, was more through the narrow channels of Zealand, 
and more in slwre than any other vessel, of any description, 
employed there ; her station being that of the leading ship of 
the squadron in shore withal ; and after the action of the 3d 
of August, I went up the narrow pass between Schowen and 
Goree, (within four miles of Williamstadt) laying not more 
than sl pistol stwt from that shore, and was the last down upon 
the retreat. There was, however, no ague in the ship but 
mine, which was, no doubt, occasioned by my wound ; and, 1 
believe, there were very few in the other vessels of Commodore 
Owen's squadron." " I had forgotten to mention that, dur- 
ing the time we were refitting at Ter Veere, the men had 
leave (to go) on shore, but never staid the whole night ; and, 
when laying off Schowen, they went on shore to bathe and 
watch, under the charge of the commissioned officer of each 
division, every evening at five o'clock ; and after bathing they 
ran races along the dykes for half an hour, but there \va< 
never any appearance of ague except in myself." 

The people of Italy have long had frequent and fatal expe- 
rience of the noxious power of miasmata, (by them denomi- 
nated MaV Aria) with which Rome, in particular, is greatly 
infested during and after very hot and dry summers: yet 
Br. Lind observes, that the effects of the Scirocco. or South 



165 

cast wind, "which passes over the adjacent marshes," have 
been experienced to extend only to the parts of the city which 
lay nearest the marshes, occasioning an epidemic fever in 
these, while the rest of the city was healthy." See his vo- 
lume on Preserving the Health of Seamen, p. 67. 

In like manner Baglivi represents the Mai' Aria of Rome, 
as acting only in particular spots or parts of the city, and as- 
serts as matter of wonder, that the healthy are separated from 
the unhealthy spots, only by very sliort spaces ;* the former be- 
ing chiefly on the northern and eastern quarters of the city, 
farthest from the river : for the Piazza, and Porto del Popolo, 
though on the north, are extremely, unhealthy, by being low 
and close to the Tiber. Indeed, marsh fevers at Rome com- 
monly begin about the Porto del Popolo. 



• Aer llomanus Squallidus est & insalubris, non quidem omnibus in locis, sed lis po- 
tissiruum quse dejicientibus sedificiis, pigro atque immoto aere sordescunt ; multo ma- 
gis si Tiberi adhserent, vel, convallium instar, montibus obsepiuntur, aut cxhalationibus 
subjacent quas vete res parietinse, cryptse, & antiquorem aedificiorum rudera emittunt 
Ex quo patet regionem Circi Maxjmi, inter Palatinum atque Aventinum si tarn, ora- 
nemque ilium campum qui inter aventinum ac Tiberim, portamque Ostieosem jacet, 
plane noxium esse & damnabilem. " ■ Quaecunque loca crebris sedificiis ambiuntur, 
atque editiora sunt, in septentrionem atque orientem spectant et multem a Tiberi 
distant, salubriora : Contra, quse sejuncta sunt & remota a frequentibus tectis, situque 
sunt humili, ac maxime in convallibus, turn propiora Tiberi, in meridiem atque 
occasum spectantia, minus salubriora judicantur : Quibus etiam in locis (~ quod sane 
minim J brevissimi intervalli disciimi?ie, hie aliquantum salubris existimatur aer ; illic 
contra noxius & damnabilis. " Baglivi Opera Omnia, p. 157, 158. 

The reason why particular spots within the walls of Home were destitute, or almost 
destitute of houses, seems to be that their (notorious) insalubrity had either destroy- 
ed or driven away tfyose who formerly lived thereon, and when the existing houses 
were decayed, had deterred other persons from rebuilding in those situations: and 
therefore, Baglivi justly mentions these places (" deficientibus sedificiis") as being 
among the most noxious. It is from a similar motive that the General Committee of 
Health, of the City of New York, in their report on ihe means of securing the health 
of its inhabitants, (dated the 20th of January, 1806) after stating that "various 
houses, in different parts of the city, have, on tlie recurrence of every malignant fever, 
proved to be the principal seats of disease, and the graves of their tenants," " suggest 
the propriety of prohibiting the same to be let or occupied as dwelling houses, that 
they maybe converted into warehouses, and that any injury sustained by the proprie- 
tors be defrayed by the public." See p. 95 of Documents, relating to the Board of 
Health, printed at Yew York, 1806. 



166 

I was repeatedly told at Rome, in the year J 802, by per- 
sons deserving of confidence, that these fevers sometimes pre- 
vailed among the inhabitants on one side of a particular 
street, whilst those on the opposite side entirely escaped their 
attacks ; and this was said to have often happened in a cer- 
tain portion of the Cor so ; the western side of which was dis- 
tinctly pointed out to me, as being much more unhealthy than 
the other.* Professor Bert he, in his work on the fever of 
Andalusia, has mentioned similar facts as occurring in some 
of the streets and squares of Cadiz, in the year 1800 ; though 
he ascribed it not to the very limited action of marsh effluvia, 
but to that of the contagion, by which he supposed the prevail- 
ing fever to have been propagated in that city. And it seems 
highly probable, that in many cases the miasmata producing 
yellow fever in sea-port towns of the West Indies, and the 
United States of America, arise from the soil immediately 
around, and perhaps, sometimes under the very houses, 
wharves, 6cc. where they are imbibed, by the persons in whom 
that fever afterwards appears. Accordingly we find that, in 
New-York, Philadelphia, Baltimore, Norfolk, and Charles- 
ton, this fever always begins, and often continues, exclusively 
in the low streets immediately adjoining to the harbours and 
wharves of these towns, except in the cases of some individu- 
als, who, after having imbibed the noxious exhalations of the 

• Similar facts are stated by Lancisi, particularly in the 3d chapter of his second 
book, de Nox. Palud. Effl. in which are several instances of marsh fevers prevailing 
in particular parts of Rome, and its vicinage, whilst other parts closely adjoining re- 
mained healthy. In one of these he says the salubrious districts might be separated 
from the insalubrious, by a diagonal line drawn, " a postica Poutificii Palatii parte, 
quam Belvidere appellant, usque ad emissarium niagnse ilhus cloacae, quae in Tiberim 
juxta Arcis tossam eo loco aperitur," &c. p. 199- And in the next page he refers to 
several authors who have attested similar events, particularly Kamazini, De Constk- 
anni, 1690, who describes a tertian epidemic, which occurred at JModena, in that 
year, but was wholly confined to the low parts, in which there was stagnant water, 
and extended no further. — " Non amphora spatia occupasse." The people in other 
parts, (which he designates) having never, w ithin their remembrance, been more 
free from fevers. " Nuoquam alias « febribus magis secures se vixissc memiuerint." 



167 

wharves and low streets in question, by residence or employ- 
ment in or near them, happen to fall sick in other situations.* 

After these observations, respecting the distances to which 
marsh effluvia may be conveyed Iwrizontallij, without losing 
their morbific power, it may be proper to inquire how far 
they are capable of retaining it, when raised perpendicularly, 
or nearly so, from their source. Unfortunately, our stock of 
facts relating this point, is even more deficient than in re- 
gard to the other ; though it is sufficient to ascertain that their 
power of exciting disease, is rapidly diminished at very small 
distances from the earth. 

Dr. Hunter, in his work on the Diseases of the Army in 
Jamaica, p. 306, says, " the barracks at Spanish Town, con- 
sist of two floors, the first upon the ground, the second on the 
first. The difference in the health of the men on the two floors 
was so striking as to engage the attention of the assembly of 
the island, (of Jamaica) and, upon investigation, it appeared 
that three were taken ill on the ground floor, for one on the 

* Being at the Horse-Guards on the lDth of November, 1810, 1 saw there Captain 
M'Koy, of the 21st regiment of foot, who had then just arrived with dispatches from 
Sicily, and was informed by him that, in July and August, 1808, while his own and 
another company were quartered at the post of Venetico, in a barrack of nearly 100 
feet in length, which consisted of one (ground) story, forty men of the latter com- 
pany, occupying one-half of the barrack, were attacked by a violent mal' aria fever, 
which proved fatal to eleven of them, but did not reach a single man of his own com- 
pany, occupying the other half of the barrack, though there was no division be- 
tween the parts or halves occupied by the two companies, nor any perceptible dif- 
ference in the soil on which the different parts or ends of the barrack stood. Each 
had, indeed, its own door to pass into and out of the barrack, but both doors opened 
on the same side ; — nor was there any difference in the discipline, diet, or manage- 
ment of the men of the two companies. Venetico is situated between JVLelazzo, 
and Messina, and is supposed to be more elevated than the Rock of Gibraltar, and, at 
least, 15(>0 feet above the sea. The barrack stood at the summit of this mountain, 
upon a rock covered by a clayey loam, and the noxious miasmata were, most proba~ 
bly, emitted more copiously from the soi' at or about one end of the barrack, than, 
that of the other, though no difference was discoverable therein. Great elevation, in 
a warm temperature, is no security against noxious vapours, if the elevated spot be 
covered by earth, containing vegetable matters, and in which clay predominates. 
Very pernicious marsh fevers notoriously prevail in such situations in the East Indies, 
(where they arc called hill fevers) and in other places within the tropics. 



168 






other. The ground floor was not, therefore, used as a harrack 
afterwards." A similar fact occurred at St. Anne's barracks, 
in Barbadoes, between the 27th July and 20th of August, 
1805, when two hundred and seventy-eight men of the 15th 
regiment of foot, then very lately arrived from England, were 
attacked by the Yellow Fever, of whom seventy-seven died. 
These men chiefly occupied the barrack which runs towards 
the sea, and is nearly at right angles with the officers' or 
stone barrack, and has " low wet ground on each side."* In 
this barrack the men on the lower floor were " taken ill in the 
ratio of three to one, of those on the upper floor." This state- 
ment I have taken from a report made to Dr. C. Ker, then In- 
spector of Hospitals in the West Indies, by Mr. Major Car- 
roll, Surgeon to the Forces, under whose care the sick in 
question were placed ; which report was dated Barbadoes, 
10th of September, 1805, and a copy of it put into my hands, 
by the writer, in November, 1806. 

Whether similar differences occur in all climates between 
the ground floor, and the next above, in regard to the influ- 
ence of marsh miasmata, I cannot determine ; I believe that 
the former are, in this respect, every where, much more un- 
wholesome than the latter. Sir John Pringle, after mention- 
ing the prevalence of intermitting and remitting fevers at 
Ghent, and still more at Bruges, in the summer and autumn 
of 1742, adds, "it was then observed that such as lay in the 
upper stories, were much more healthy, than those who were 
below in the ground floors, which were all very damp." (Dis- 
eases of the Army, p. 13.) The same ill effect upon the 
ground floors was experienced during the late expedition at 
Walcheren, and, therefore, Drs. Blane, Lempriere, &c. in 
their report- to the Secretary at War, lately mentioned, say, 



* Dr. Chisholm, alluding to this part of Barbadoes, observes, that, " the eastern 
side, where Constitution Hill is situated, and where the kingVhouse, and an t-xten- 
sive barrack siand, is thought to be affected by marshv miasm, from a branch of the 
sea, which runs a considerable war mte the country." Essay on Malignant Pestilen- 
tial Fever, &c. vol . 2, 1 60. 






169 

" on no account should ground floors be used as sleeping apart- 
ments. The more lofty the buildings the better ; for the te- 
nants of the upper stories, not only enjoy the best health, but 
when taken ill, have the disease in the mildest form ; an in- 
stance of which came under our observation when we visited 
Fort Ramakins, and the same is confirmed by the experience 
of the natives." When the small elevation of a single story 
(not exceeding twenty feet) from the ground, is found so 
greatly to diminish the power of noxious exhalations, it might 
be expected that the tops of hills rising a few hundred feet 
above the level of the sea, or of the surrounding country, 
would always be found healthy. Experience has, ho\vever> 
often proved the contrary r particularly on the Morne-foiiune 
at St. Lucie, and on the Hospital, and Richmond Hills, at 
Grenada, where very great mortality has repeatedly occurred 
among British soldiers. But in these and similar cases it 
seems probable that the soil, at or near the tops of these hills, 
contained matters suited to the formation of marsh miasmata, 
witli sufficient proportions of clay to retain the necessary 
moisture. There can, indeed, be no doubt, that this is the 
case of the Morne-fortunt, which I observed to be very wet, 
and, in some degree, swampy. This and Richmond Hill, 
being at their tops more than seven hundred feet above the 
level of the sea, could not, I am persuaded, be so greatly af- 
fected merely by exhalations from any low and damp grounds 
in their neighbourhood. 

After these facts, relating to the heights and distances at 
which marsh effluvia may be conveyed from their source, so 
as to produce fever, it may be proper to notice the greater 
degree of noxious power, which they are supposed to exert, 
when applied to the body during the night, than when ap- 
plied in the day. This greater noxious power in the night, 
and especially during sleep, has been strongly asserted by 
Lancisi, de Noxiis paludum effluviis, p. 77, &c. ; and he was 
so perfectly convinced of the fact that he has devoted a parti- 
cular chapter, (the 21st) to explain the cause. " Cur juxta 

22 



170 

paludes noctu prsesertim indormientes* magis quam vigilantes 
lsedantur?" And he begins this chapter by saving, "Nemo 
Arbitror de facti veritatc dubitabit qui din medicse arte ope- 
ram dederit f and then declares. " Nos certe Romana N oso- 
comia per sestatem, & autumnun plena videmus miseris agro- 
rum colonis ; ac per urbem ssepe dolemus incautos venatores, 
ac peregrines, quamquam non longo tempore palustria loca 
incoluerint, quia tamen brevem somnum prope lacunas csepe- 
runt, malignis febribus afflictari." These facts he ascribes 
partly to an increased susceptibility of our bodies, " quae in 
somno ad labem suscipiendam proniora fiunt," and partly to 
a difference in the condition of the effluvia themselves, "quae 
per noctem prsecipue deteriora evadunt f 9 and he explains the 
cause of this difference in these words, " Quod vero attinet, 
ad effluviorum pravitatem, certe eadem post solis occasum 
perniciorior est : quidquid enim per vim solis attenuari, dis- 
siparique continget, eo recedente, concretione gravius effici- 
tur, terraeque rursus incumbit, et dormientes infestius adori- 
tur," &c. p. 79. Lancisi refers to several authorities and 
instances in support of his assertions and opinions, and con- 
cludes by admonishing those who, in summer, travel through 
the Pontine marshes, between Rome and Naples, even with- 
out sleeping, not to do it at night, as was too often done, to 
avoid the greater heat of the day.* Similar admonitions 
are still given at Rome to all strangers, and they are founded 
on the uniform experience of ages, which has afforded nume- 
rous instances of travellers, who, in consequence of their pas- 
sing these fens during the night, (though the passage requires 
but six or eight hours) have been attacked with violent and 
mortal fevers. This is confirmed by Baglivi, in the following 
words : " Vetus enim Latium desertum fere hodie est, & squa- 

* " Neque vero solum dormientibus noxius est per noctem palustris aer ; sed etiani 
iis qui vigilantes per coenosa loca interfaciunt. Qua de re monitos vellem quotquot vel 
Neapoli Romam, vel Roma Neapolim contendunt, ut <iiumos pouu:- rstus subt ant, 
quam nocturni frigoris voluptate decepti contemeratam ambientis aeris vim excipiant,'' 
&C. p. 80. 






171 

lidum ; Austri flatibus immediate objecitur ; & variis ejusdem 
in locis, insaluberrimus aer observatur, ut pote circa 0stiam 9 
et Portum aestivo prsesertim tempore ; quo quidem si aliquis in 
praefatis, aliisque Latii locis pernoctaverit, & exinde urbem 
revertatur, corripitur statim maligna febri, quam vulgo ex 
mutatione aeris dicunt." Opera Omnia, p. 158. 

It will be recollected, that in the instance of the Phenix 
Ship of War, mentioned at p. 96 of this volume, " none of 
those who slept on shore escaped the sickness, and only three 
of them survived it ;" and that, though nearly all the rest of 
her crew, consisting of 280 men, went, in parties of twenty 
or thirty, at different times, on shore in the day, and " ram- 
bled about the island hunting and shooting" — " bartering for 
provisions, washing linen," &c. " not one of those who re- 
turned to the ship at night was taken ill, or suffered even the 
slightest indisposition." And that exactly similar effects oc- 
curred the following year, with the same ship at the same 
place, where " she lost eight men out of ten, who had impru- 
dently remained all night on shore ;" whilst the rest of the 
ship's company, " who, after spending the greatest part of the 
day on shore, always returned to their ship before night," 
" continued in perfect health." In like manner the crew of 
the Hound Sloop of War, (then in company with the Phenix,) 
by never sleeping on shore, continued in good health. It may 
be recollected also, that in the cases of the Ponsborne and 
Nottingham East Indiamen, (p. 99) those who had slept' on 
shore were exclusively attacked by the fever ; and, in parti- 
cular, that " the carpenter (of the Ponsborne) and his crew, 
nine in number, by their all sleqring on shore, catched the fe- 
ver and died, except one, who was a negro. The effects 
were exactly similar in the cases mentioned by Drs. Clark 
and Trotter, (p. 99 and 100) and in that of Fontana. Dr. 
Lind has, moreover, in different places, mentioned other in- 
stances of similar morbid effects, resulting from exposure to 
marsh effluvia by night, and the like has been done by Dr. 
Blane, Dr. John Hunter, &c. &c We have, therefore, 






172 



reason to believe, not only that the morbid miasmata are con- 
densed or precipitated with the falling dews, by the diminish- 
ed temperature of the night, and thus accumulated near the 
surface of the earth, but that the body is rendered more ac- 
cessible to their noxious influence during sleep, by its greater 
relaxation, and by a suspension of those protecting exertions 
of the living power, which accompany our wakeful exercises. 
Perhaps something may also be owing to the fact discovered 
by Dr. Ingenhouze, that vegetables only emit azote or nitro- 
gen at night, instead of the oxygenous or vital air, which is 
copiously separated from their leaves when exposed to the 
sun's rays. 

I ought, were it possible, here to ascertain how, and 
through what channels, the morbid influence of marsh effluvia 
is applied to, and exerted upon, or within the body, so as to 
become the cause of fever. But here our knowledge is bu1 
little better than complete ignorance. The miasmata, in 
question, being absolutely imperceptible by any of our senses, 
can only be known by the disorders which they excite : these, 
however, are not such as to indicate the manner in winch the) 
were produced, nor the passages by which the morbific power 
has gained admittance. The throat, trachea, bronchia?, and 
lungs, obviously present themselves, as the parts through 
which all aeriform and respirable substances might be most 
readily and naturally introduced within the system, but these 
parts appear to suffer much less than the stomach, brain, and 
nervous system, from the impressions of marsh miasmata : 
and as there is much uncertainty and difficulty attending 
every explanation which has occurred to me on this subject, ) 
shall abstain from proposing any ; and proceed to enquire, 
how soon these miasmata, after being sufficiently applied to 
the body, commonly produce fever, and how long they may 
remain inactive therein, without manifesting anv change or 
effect. 

On this subject Dr. Lind says (p. 182 of his work on the 
Diseases of Europeans in Hot Climates) that « from com- 



173 

paring many instances of people who have slept on shore dur- 
ing the sickly season, and in consequence of it, who alone 
have been taken ill out of the whole ship's company, then lying 
in an open road, it appears that some are immediateltj 
seized with sickness or delirium, many are not seized with 
either, till they have heen on board two or three days ; several 
have been only slightly indisposed for the first five or six 
days ; and, in a few, the symptoms of indisposition have not 
appeared before the 10th or 12th day." 

The same author (on Preserving* the Health of Seamen, 
p. 78) says, " there are numerous instances of boats' crews 
having suffered greatly by sleeping near the mangroves, with 
which the sides of rivers are frequently planted in the torrid 
zone. I have known the whole of a boat's crew seized next 
morning witli bad fevers." And at p. 81, he mentions a simi- 
lar fact, communicated by the Surgeon of a Guinea Ship, 
which, going u up one of the rivers for the sake of trade, it 
Avas found very dangerous to sleep on shore." — " First the 
captain, then the mate and two or three seamen were taken 
ill, each of them the morning after they had lain on sJwre" 
But such very sudden attacks of fever from marsh effluvia 
are, I believe, uncommon, even in the hottest climates or 
worst situations. They, indeed, occur not unfrequently with- 
in four or five days; but are much oftener delayed until the 
9th, 12th, and 15th days, after exposure to marsh miasmata, 
even at Batavia, Gambia, St. Thomas's, Mohilla, &c. Dr. 
Jackson, who, like some others, is disposed to believe that 
these attacks " take place chiefly at septenary periods," 
asserts " from his own observations made upon numerous 
bodies of men," — and upon healthy soldiers, sent to the con- 
centrated sources of endemic fever," that " among such, fever 
scarcely ever appeared before the seventh day, commonly not 
before the fourteenth; and in numerous instances, not till 
the expiration of six weeks or two months, though the cause 
of disease, during this time, was ordinarily in great activity." 
Outline, k& of Fever, p. 248. 



174 



Dr. John Hunter observes, that w after the human bodv 
has been exposed to the poison, (of marsh effluvia) sometimes 
a longer, sometimes a shorter period elapses, before a fever is 
produced. " Men, (he adds) on the watering service, are 
not all taken ill at the same time ; some fall sick the first or 
second day, others not till several days, after they have ceas- 
ed to be exposed to the cause of fever, by returning on board 
of ship." — " Some have embarked on board the ship in good 
health,- and have been seized after ten or fourteen days with 
the remittent fever. Examples in this way have come to my 
knowledge, of the fever appearing three weeks after ceasing 
to be exposed to the cause of it." Observations on the Dis- 
eases of the Army in Jamaica. — He adds, in a note to p. 329, 
that, " it would be curious and interesting in the history of 
the remittent fever, to ascertain the interval that may take 
place between exposure to the cause, and the appearance of 
the disease;" and then mentions the West Suffolk regiment of 
Militia, called, in 1793, from their own county, one of the 
healthiest in England; to Hilsea barracks, of which the 
"low, marshy, and unhealthy situation, has been fatally 
known to the army, since their first erection." The men 
were then " all in perfect health ;" — but •' became very sick- 
ly ; and twenty-two died of fevers, before they left the bar- 
racks," about the end of June following. In July this regi- 
ment, with eleven other battalions, was encamped at Mater- 
down, in the neighbourhood of Tunbridge Wells, and u their 
sick list soon amounted to 100, out of 500," among which 
were many with fevers, that " had all the marks of a bad 
remittent;" some of which terminated fatally — and the deaths 
in this regiment exceeded the amount of those in all the eleven 
other battalions together, on the same ground. But the point 
of most importance is that some of this regiment u were 
taken ill of the fever, in the month of October, icho had m 
had it before; 99 i. e. nearly four months after their removal 
from « the cause of the disease, at Hilsea barracks" 






175 

In addition to this, he mentions the case of the 18th Regi- 
ment of Foot, in 1783 and 1784, as stated by Mr. Venour, 
then Surgeon of the regiment, and now Deputy Inspector of 
Hospitals. By his statement it appears, that the 18th regi- 
ment, after having been stationed at Hilsea barracks, from 
the 22d June, 1783, to the 9th October following, was then 
embarked for Gibraltar, where, though the regiment consisted 
only of 400 men, the number of agues was increased, by the 
beginning of May, to 280, including women and children, — 
of whom a considerable part were then recently attacked for 
the first time; and whilst no agues existed in any other part of 
the garrison. On these facts, Dr. Hunter remarks, (p. 334,) 
that " the 18th regiment of Foot, and the West Suffolk regi- 
ment of Militia, after leaving Hilsea barracks, were both in 
situations where they could not contract fevers, and the regi- 
ments encamped with the latter, and those in garrison with 
the former, had no fevers. There cannot, therefore, be a 
doubt that the poison had remained quiescent in their bodies 
for four, five, and six months." When thus poisoned, " get- 
ting wet in the open air, proved a strong existing cause of 
fever, as was observed both in the West Suffolk and 18th 
regiments." He adds, " ships returning from a warm cli- 
mate, particularly if they have been in harbour during the 
unhealthy season, have many of their men taken ill of the 
remittent fever, even two or three months after being at sea ; 
and care should be taken, not to confound this fever with 
what is called the Jail, Hospital, or Ship fever." P. 335. 

Extraordinary as these facts appeared to be, when first 
made known, the fullest confirmation of them has been since 
produced by the late expedition to Zealand ; in which it has 
been indisputably ascertained, that considerable numbers, both 
of officers and soldiers, who were employed on that service, and 
who escaped the sickness, whilst at Walcheren, and other 
parts of Zealand, were attacked by intermitting fevers, and 
some of them as late as six, seven, eight, and even nine 
months, after being brought back to this country; though 



176 

care was taken to place them generally in situations remote 
from all the known sources of marsh miasmata. This fact is 
now become notorious ; I have seen it verified in the returns 
of several regiments, and it has been confirmed to me by a 
great part of the physicians, and by several of the surgeons, 
both staff and regimental, to whose care the sick of that army 
were committed in this country. 

We may, therefore, now understand, what had before ap- 
peared to me very difficult to explain satisfactorily ; I mean 
the cause of those intcrmittents which occur, more especially 
in fenny countries, at an early part of the spring and summer : 
before the soil or atmosphere can be supposed to have, at any 
time, in that year, acquired sufficient warmth, either to form, 
or extricate marsh miasmata, capable of producing fever. 
Consequently vernal intcrmittents may now he considered a? 
resulting from miasmata received into the body during the 
preceding summer or autumn, and (after having remained in a 
quiescent state during winter) rendered active by some excit- 
ing, or proximate, cause of fever in the spring. It may he 
presumed, however, that in such cases, the original dose, if I 
may so call it, of marsh miasmata, was but moderate, be- 
cause its effects would otherwise have been sooner manifested, 
and this will account for the well know n mildness of * ernal 
intcrmittents, and the facility with which they are generally 
cured.* 



* Dr. Jackson, at p. 60 of his Outline of the History and Cure of Fever, mentions 
a detachment who were embarked at the Mole, in St. Domingo, for St Marc, and 
landed on the Sd of June, among which several were taken ill of Yellow Fever, du- 
ring the passage, and twenty were sent on shore from one ship with that disease, after 
her arrival at St. Marc, of whom eleven or twelve died, within four days, though they 
>vere all apparently in good health when embarked. He also mentions, as a circum- 
stance which " appeared inexplicable?" that at St Domingo, " uncommon sickness 
and mortality took place under every transportation of troops, to different po*ts." 
It seems probable, however, that, in all these cases, the troops had previously imbibed 
certain portions of marsh miasmata, which, though quiescent for some time, ac- 
quired a morbid activity by sea sickness, getting wet, or other debilitating causes, du- 
ring their transportation from one port to another. It is even probable, that actual 
disease was sometimes produced by such caves, in persons whose constitutions might. 



, 177 

From all these facts it may be inferred, that by differences 
either in the quantity or quality of the noxious exhalations of 
marshes, their operation, as a cause of fever, is liable to great 
varieties, in regard to its celerity, or the length of time in 
which disease actually appears; which is sometimes within 
twenty-four hours, and sometimes not until six, eight, or even 
nine months have elapsed, and then only when assisted by 
some accidental or exciting cause. The longest periods, so far 
as I can discover, have occurred exclusively in cold, or tem- 
perate climates ; the shortest, only in the hotter ; and in ge- 
neral there seems to he some foundation for believing, that, 
ceeteris paribus, the disease will be most violent in those cases 
where it appears soonest after the morbid cause has been ap- 
plied to the body ; and that the rapidity of its production, will 
be in proportion to the quantity and concentration or force of 
the noxious miasms ; differing in this respect from the small- 
pox, and some other specific contagions, whose morbid influ- 
ence, together with the mildness or severity of the disease re- 
sulting from it, seems to depend exclusively upon the state of 
the body, in which it is exerted, and the treatment of the pa- 
tient in regard to temperature, diet, &c. 6cc. and not upon 
either the quantity or quality of the contagion, producing the 
disease. The state of the body, indeed, and other circum- 
stances, have a considerable influence in regard to the mild- 
ness or severity of the fever from marsh effluvia, but not an 
exclusive one, as they seem to have in regard to the effects, of 
several, at least, of the specific contagions ; e. g. Dr. John 
Hunter observes, that if persons are exposed to the exhala- 
tions of marshes, " when fatigued by hard labour and long 
lasting, the poison gains admission more readily into the 
body, and produces immediately the worst kind of fever. It 
is in this way, (he adds,) that soldiers suffer so much on ac- 
tual service in the West Indies : the few cases of fever which 

under more favourable circuvustunc";, have withstood, and finally subdued the poison, 
without any attack offerer. 

23 



178 



proved fatal in twenty-four hours, that occurred to me, were 
all contracted in a similar manner." (Diseases of the Army 
in Jamaica, &c.) 

There is, however, another condition of the bodij, which is 
of great importance, in regard to the production of yellow fe- 
ver, and which, therefore, requires a particular investigation ; 
I mean the cause of that remarkahle susceptibility to this dis- 
ease, which is commonly found in persons who have just ar- 
rived at places where it occurs, from cold or temperate cli- 
mates; and of the equally remarkable exemption from it, 
which is commonly experienced by the old inhabitants of hot 
countries ; and which, in the latter, is universally ascribed to 
their having become seasoned, as it is called ; but however 
familiar this term may be, and of whatever importance its 
proper signification really is, (since it involves the means of 
preservation from one of the most dreadful maladies which 
afflict the human race) it has been long employed either with- 
out any precise meaning, or with meanings which ape inad- 
missible. Thus it is often said, that a person is seasoned who 
has once had the Yellow Fever ; but very improperly, because 
the same individual may have the disorder several times ; be- 
sides which, many persons become exempt from the fever, and 
ought, therefore, to be considered as being truly seasoned, 
without having ever suffered an attack of the disease. It is, 
also, frequently believed, that one may become seasoned by re- 
siding long in those towns in which the Yellow Fever is apt to 
recur ; but the very great numbers of the inhabitants of Phi- 
ladelphia, New- York, Malaga, Cadiz, Seville, &c. who have 
been swept off by the distemper, within a few yeai-s, are me- 
lancholy proofs that an efficacious seasoning is not to be ac- 
quired merely by such residence. Nor can it be said, that 
those who live near marshes are peculiarly seasoned, because. 
in hot countries, numbers of persons, who live at a distance 
from marshes, are proof against the Yellow Fever, although 
they are sometimes attacked witli slight remittents, or inter- 
mittents. 



179 

After some reflection on this interesting subject, the various 
degrees of susceptibility which are observed in different indi- 
viduals, or in different places, seem to me capable of expla- 
nation on a ver> simple principle, I mean the effects of tem- 
perature on the human frame, which does not appear to have 
been sufficiently noticed. 

The body, whilst in health, is found always to be, with 
very slight variations, at the temperature of 98 degrees of 
Fahrenheit's thermometer, and there is good reason to think, 
that any considerable variation from this point would neces- 
sarily produce morbid effects. It seems, therefore, to be of 
high importance, that the body should be preserved from such 
deviations ; and the author of nature has, accordingly, pro- 
vided efficacious means for that end : — different opinions are, 
indeed, entertained concerning these means ; and since the 
later chemical discoveries have been made, it has been gene- 
rally believed, that, in an atmosphere, the temperature of 
which is less than 98 degrees, the heat of the human body is 
maintained at that point, by a process similar to that of com- 
bustion, and depending upon a combination of oxygen gaz 
(taken into the lungs by respiration) with carbon and hydro- 
gen : and that, in an atmosphere heated above 98 degrees, 
the temperature of the body is kept down at that point by the 
effect of an evaporation of matters perspired from the skin. 
There are, however, insurmountable difficulties opposed to 
this doctrine; but a full statement of them would, in some 
degree, be foreign to the subject under our consideration.* 

* In June, 1794, 1 controverted this chymical doctrine, regarding the production of 
animal heat, at an act, or public exercise, in the University of Cambridge, previous to 
the taking of my first degree in physic. Perhaps a summary of some of the facts and 
arguments, which render that doctrine inadmissible, may be acceptable here. 

1st. Animal heat is a natural production : and no chemical process like combustion 
can take place naturally in a healthy animal, because the power of life, while it subsists, 
naturally counteracts and suspends all chemical attractions, or affinities within the 
body ; and even, after death, when this suspension is removed, they spontaneously occa- 
sion a different process, that of putrefaction. 



180 

I will, therefore, at present, only remark, that it is utterly in- 
credible that these opposite processes should ever be carried on 
so accurately in reference to each other, and be so exactly ba r 
lanced, as invariably to keep the body at the heat of 98 de- 



2d. The attractions or affinities subsisting between oxygen, hydrogen, and carbon, 
even if unrestrained by the living power, would not, so far as our knowledge extends, 
enable them, by combining to form water, and carbonic acid gaz, with a disengagement 
of sensible heat, as, according to this doctriae, they are supposed to do, unless they were 
actually ignited, which they never can he in the lungs or blood-vessels of an animal in 
health. 

3d. Were it even possible, that the air naturally inspired by the lungs should com- 
bine and afford heat in the manner supposed, the heat, so afforded, being necessarily 
limited and proportioned to the quantity of oxygen inspired, would, at all times, be 
greatly insufficient for maintaining the human body at its natural temperature, even in 
the milder parts of Europe ; and, in an atmosphere below the freezing point, it would 
greatly fall short of the quantity of heat commonly abstracted from the body, and . car- 
ried out of the lungs, by the warm moist vapour copiously expired from them. So 
that in cold, and even in moderate weather, one effect of respiration is to cool the 
blood, according to the opinion which, during several ages, prevailed on this subject- 
And, if the quantity of oxygenous gaz, naturally inspired by mankind, be incapable of 
affording heat, sufficient to maintain their natural temperature, the quantity inspired b\ 
animals of the celaceous order, must be yet n ore, and much more, insufficient to main- 
tain the heat natural to them, living, as they commonly do, from choice, at the edges 
of ice, near the poles, and immersed in a fluid, (salt water) so well suited to abstract, 
and rapidly conduct away their heat, however it be acquired. The degrees of animal 
heat naturally belonging to the several genera and species of this order, have not been 
accurately ascertained ;— it is known, however, to exceed that of mankind in some, 
and probably, does so in all of them. Some of the sptcies of whale, particularly the 
JBalcena tnysticetus, (the common or larger whalebone whale) are of an enormoos 
size, and from 50 to 100 feet in length; in a few places they are said to have been 
found 160 feet long. And, it is ascertained that, in most animals # of this order, the 
passage- for air through a part of the trachea, is proportionally " very small or con- 
tracted ;" and that the pulmonary cells are smaller than in quadrupeds, which, - 
Mr John Hunter, " may make less air necessary."' (See his Observations on the Struc- 
ture and Economy of Whales, in the Phil. Trans vol. 77, p. 418, 419) And as 
these animals, in addition to the smaller quantity of air taken in their lungs at each in- 
spiration, do not commonly breathe oftener than once in about fifteen minutes, 
-when frightened, only once in about haif an hour, (See lMiil. Trans. No. 5S7, p. -_Y 
it must be absolutely impossible that oxygen, so spaiinglu received into their lungs, 
should, upon any principles vet known, afford supplies of heat sufficient to 
maintain the high natural temperature of these animals, (whose ceconomv nearlv resem- 
bles that of men and quadrupeds) in the cold water, by which thev are surrounded. 

Finally, to avoid unnecessary proofs, and demonstrate beyond the chance of con- 
tradiction, that animal heat is not produced by respiration, v»e need only rtfUect, 



181 

grees, in all tlie diversities of temperature that occur in dif- 
ferent climates and situations, and, therefore, that this im- 
portant conservatory function must depend on a power more 
exalted in its nature, and more certain in its operations ; which 
can be no other than the power of life, — a power which, in 
proportion as it is more vigorous in robust individuals at the 
prime of life, notoriously enables them to resist the opposite 
extremes of heat and cold, and preserve their bodies at the 
proper standard, more perfectly, and for a greater length of 
time, than at a more advanced age. I will not venture to as- 
sert that no addition to the heat of the body can be made, 
either directly or indirectly, by the combination of oxygen 
with the blood, and I readily admit, that its temperature ma) 
be diminished by a copious evaporation from the surface ; — 
but, if either of these causes should co r operate with the living 
power to a small extent, the one in raising, and the other in 
lowering, what is called animal heat, it must always be in 
complete subordination to the higher principle of which I have 
been speaking, and to which nature lias committed the impor- 



(wliat is well known) that it continues to he produced for some time after respiration 
has entirely ceased, more especially in persons who die by apoplexy, or by suffocation, 
from fumes of burning charcoal, he who are frequently observed to retain their for- 
mer temperature undiminished for several hours after all breathing has stopped ; and 
in some cases, it has even been raised above the standard of health; e. g. Dr. Clarke, 

(on Diseases, Sec in Long Voyages, vol. 1, p. 41,) says of a seaman, who died by apo- 
plexy, from a " coup ds so/e/7," that, after all the external signs of life had disappeared, 
when " no motion was to be felt in the thorax, nor any pulsation in the arteries;" 

when his jaws were locked, his eyes dead, and staring, " the heat of his body was much 
above the standard of health, and communicated a burning pungency to the touch; he 
was bled largely from the arm and jugular ; the blood was very hot, and it was with 
difficulty stopped." Indeed, heat continues to be more or less generated in all persons 
after what is called death, so long as they retain any portion of excitability or living 
power. Were it not for this they would be reduced to the temperature of the sur- 
rounding atmosphere, as speedily as another body of the same species and size, 
which, after being absolutely dead and cold, had been artificially heated to the same 
degree. 

The natural heat of vegetables seems to be analogous to that of animals, and 
equally the product of a living power, independently of any process resembling 

combustion. 



182 

tant charge of preserving the temperature of the body at the 
standard of health, amidst all the varieties of climate, and of 
external circumstances. This is a charge which cannot be 
fulfilled in an atmosphere like that of England, the mean tem- 
perature of which may be estimated at 50°, without a consi- 
derable expenditure of the living power, in order to generate 
constantly, at the mean rate of 48° of animal heat : and after 
the body has been, for a length of time, accustomed to make 
this exertion, it is easy to perceive that, upon removing into a 
warm climate, such as that of the West Indies, tlie general 
mean temperature of which may be taken at 79' or 80°, very 
material changes in the functions of the system become abso- 
lutely necessary for the preservation of health. But these 
changes are not to be suddenly effected ; and, until the body 
becomes perfectly accommodated to the heat of this new cli- 
mate, the whole animal ceconomy must be considered as al- 
most in a state of morbid excitement.* It is not this state, 



* There is a great analogy between animals and vegetables in regard to their pre- 
disposition, from habit, to generate certain portions of heat; and in tfieir susceptibi- 
lities from the Si«me cause, of being inonlinately excited by a removal to climates or 
situations, Mariner than those to which they have been accustomed, Mr T. A Knight, 
in his " Observations on the Method of Producing New and Early Fruit,'* (in the 
Trans, of the Horticultural Society, part 1, p. 30) mentions the following facts: 
"If two plants of the vine, or other tree of similar habits, or even if obtained from 
cuttings of the same tree, were placed to vegetate during several successive segsons in 
very different climates ; if the one were planted on the banks of the Rhine, and the 
other on those of the T^ile, each* would adapt its habits to the climate in which it was 
placed ; and, if both were, subsequently, brought in early spring into a climate simi- 
lar to that of Italy, the plant, which had adapted its habits to a cold climate, would 
instantly vegetate, whilst the other would remain perfectly torpid. Precisely the same 
thing occurs in the hot-houses of this country, where a plant, accustomed to the 
temperature of the open air, will vegetate strongly in December, whilst another plant, 
of the same species, and sprung from a cutting of the same original stock, but habi- 
tuate&to the temperature of a stove, remains apparently lifeless. It appears, there- 
fore, that the powers of vegetable life in plants, habituated to eold climates, are more 
easily brought into action than in those of hot climates ; or, in other words, that the 
plants of cold climates are most excitable." P. 191. " I?ut, the influence of climate 
on the heat of plants, will depend less on the aggregate quantity of heat in each 
climate, than on the distribution of it in the different seasons of the year The 
aggregate temperature of England, and of those parts of die Russian empire, that 



183 

(of excitement) however, which alone is productive of fever ; 
since we know that innumerable persons have gone from 
Europe to the hottest regions of the globe, and have continued 
there for years, without being attacked by fever, when other 
causes did not assist in producing that disease. The inhabi- 
tants of South Carolina, as I lately mentioned, were exposed 
to this kind of excitement, in an extreme degree, during a 
great part of the summer of 1752, and yet had never been 
more healthy ; and other instances of the same import, might, 
if necessary, be adduced. But, although the simple operation 
of the warmth of hot climates upon the human body be not the 
cause of this disease, yet it is chiefly, if not entirely, to the 
various degrees of that derangement which it occasions in per- 
sons not accustomed to warm climates, that I attribute all 
those varieties of liability to the epidemic Yellow Fever, 
which are observable in different individuals, from the ex- 
treme susceptibility of northern strangers to the almost com- 
plete immunity of Creoles, and more especially of African ne- 
groes. It may be very difficult to point out the particular 
means by which heat occasions this extreme susceptibility; 
and yet it is not difficult to understand, that a morbid cause 
may be able to produce a much more violent disease, when it 



are under the same parallels of latitude, probably does not differ very considerably ; 
but, in the latter, the summers are extremely hot, and the winters intensely cold ; 
and the changes of temperature between the different seasons are sudden and violent. 
In the spring, great degrees of heat suddenly operate on plants which bave been long 
exposed to intense cold, and in which excitability has accumulated during a long period 
of almost total inaction ; and the progress of vegetation is, in consequence, extremely 
rapid. In the climate of England, the spring, on the contrary, advances with slow 
and irregular steps, and only very moderate and slowly-increasing degrees of heat 
act on plants in which the powers of life has scarcely, in any period of the preced- 
ing winter, been totally inactive. The crab is a native of both countries, and litis 
adapted alike its habits to both ; the Siberian variety, introduced into the climate 
of England, retains its habits, expands its leaves, and blossoms on the first approach 
of spring, and vegetates strongly in the same temperature, in which the native crab 
scarcely shows signs of life ; and its fruit acquires a degree of maturity, even in the 
early part of ah unfavourable season, which our native crab is rarely or never seen 
to attain/' 



s 



184 

is assisted by the co-operation of so powerful an agent as 
Iieat, than it could produce when acting by its own single in- 
fluence ; and it is upon this principle that I shall endeavour 
to explain the general law, by which the susceptibility to the 
Yellow Fever is, ceteris paribus, regulated. To accomplish 
this object, it will be necessary to take a concise view of the 
climates, in which the Yellow Fever has principally raged, 
and to apply the principle just mentioned to the results, 
which the experience of several years, in each of them, has 
afforded. 

The variation of temperature, to which the climate of the 
West Indies is subject in the course of the year, is comprised 
within a few degrees ; for the mercury in the thermometer sel- 
dom descends below 70° during the winter months, even in 
the coolest part of the mornings, and I have rarely found it 
(in the smaller or windward islands) to rise above 88° in the 
shade on the warmest days of the summer ; though the heat is 
said to be sometimes a little greater in St. Domingo, and the 
other large islands. The excitement in the system, -which 
ensues immediately upon a persons coming into so warm a 
climate from a temperate region, renders him, as I have al- 
ready said, eminently liable to the Yellow Fever, when expo- 
sed to the influence of marsh effluvia : bv decrees, however, 
the excitability producing this commotion abates, and, at the 
end, sometimes of twelve months, but oftener of a year and 
half, or two years, he acquires the power of supporting this 
high temperature, and then becomes almost as insusceptible of 
the disease, as the natives or old inhabitants : and afterwards 
retains this happy immunity, so long as he continues in that 
climate, the great uniformity of which does not, indeed, af- 
ford him any means of losing it. He may, likewise, go from 
the West Indies to those parts of North America, or of Spain, 
where the Yellow Fever is raging with the utmost fiury, with 
almost a certainty of escaping the disease : and even if he 
should not preserve his health perfectly in such situation^, he 
will, at the worst, be onlv seized with a mild remittent or in- 



185 

termittent fever, though living in the midst of those who are 
dying with the yellow fever in its aggravated forms. 

The horrid massacres and pillage of the white proprietors 
in the French West Indian Islands, by their negro slaves, (in 
consequence of the principles instilled by the French revolu- 
tion) had so alarmed the wretched survivors, that great num- 
bers of them fled for safety to different parts of the United 
States. We were about three thousand French, says Dr. 
Valentin, (the author of a late Treatise on the Yellow Fever, 
who was, himself, one of that number,) when we landed at 
Norfolk and Portsmouth, in the Bay of Chesapeake, in July, 
1793, after the dreadful catastrophe at the Cape : some of 
those who remained in these towns were seized with a remit- 
tent, but not one with the yellow fever, although our sudden 
transition from affluence to absolute want, might have been 
fully capable of predisposing us to this malady, which a stag- 
nant and heated atmosphere, and a low swampy situation, 
seemed, of necessity to produce, in the country in which we 
arrived. (Page 68.) 

Many of these refugees were also living at Philadelphia in 
the same summer of 1793, during which above 4000 of the 
inhabitants died of the distemper ; but (as we are distinctly 
told by Dr. Rush,) they universally escaped it. In this place, 
however, it will be proper to remark, that the immunity 
which Creoles possess, relates chiefly to that variety of yel- 
low fever which is epidemic. I have already mentioned that 
a fever, attended with all the symptoms which are held cha- 
racteristic of the yellow fever, may, in hot climates, be 
brought on by intemperance, great fatigue after being over- 
heated by the sun's rays, sudden diminution of temperature, 
violent agitations of mind, and other causes, which are known 
to be capable of exciting fever in all countries : to this spora- 
dic fever Creoles are subject, though in less violent degrees 
than Europeans ; for no length of residence in any climate 



24 



186 

can be supposed to exempt one from the operation of such 
xauses.* 

The climate of the United States of America is very unlike 
that which prevails between the tropics ; for the variation of 
temperature, within the year, is not in the former limited to 
18 or 20 degrees, as in the latter, but extends from 60 to 
80 degrees ; the heat in summer being often greater than in 
the West Indies, and the cold in winter being in many parts, 
much below the freezing point. Nor does the same climate 
prevail over all the states ; for although, during the warmest 
part of the year, the heat being nearly as great at Philadel- 
phia, New- York, and other towns in the latitude of 40 or 41 
degrees north, as at Charleston, in South Carolina, which is 
seven or eight degrees nearer to the equator, yet the annual 
mean temperature of the more northern states, is considerably 

* Dr. Lempriere does not seem to believe that tliese causes alone will produce the 
fever in question. He says, (Diseases of the Army in Jamaica, vol- ii p. 118) "that 
how much soever persons are exposed to the sun where marsh miasma does not pre- 
vail, the attack of fever does not ensue; and that, whenever there has been an in- 
stance of Idiopathic fever, in situations that are deemed healthy, it will be found, 
upon careful inquiry, that the patient had been exposed to marsh miasma, in an occa- 
sional visit to some place where it exists " That this may often be true I believe, but 
not that it is always so; for, though mere exposure to the sun, without a sudden 
cooling of the body, or the co-operation of some of the other causes just mentioned, 
may not be sufficient to produce fever, yet I am fully convinced of its having done so, 
not unfrequently with such co operation. But, whether the fever so produced, will 
be, in all other respects, exactly similar to an Idiopathic fever produced in the way 
which Dr. Lempriere supposes, and especially, whether it will have an equal tenden- 
cy to remit, is more than I am willing as yet to decide. 

Though Dr. Hillary practiced, with the highest reputation, in Barbadoes, for a 
considerable number of years, there is £ood reason to believe that all the cases of 
yellow fever which fell within his observation, were merely sporadic, and most of 
them produced by some of the causes which I have mentioned, as sufficient for that 
purpose ; and it must be principally to such cases that Dr. Lind alludes, at p. 120 of 
his volume on Preserving Health at Hot Climates, when he says, "I am very sensi- 
bh that one or two persons may sometimes be seized with the vellow fever, when 
no other person in the neighbourhood labours under it ; and even that, at such a 
time, its most mortal symptom, the black vomit, may attack a person newfy arrived, 
wi.hout any previous complaint " He afterwards observes, at p 178, that " drunk- 
enness, or any debauch, will often give a fever, which in less than forty eight hours 
terminates in die death of the patient." 



187 

less than that of the southern, because, on the one hand, the 
season of heat is of shorter duration, and, on the other, the 
winter is much more severe in the former than in the latter. 
The cold at Philadelphia, for instance, is so great, that the 
Delaware " river is frozen from three to nine weeks almost 
every winter,"* and is yet more intense at New- York, and 
in most of the towns of New England: but at Charleston, as 
we are informed, by Dr. Chalmers, " it seldom freezes mere 
than four or five times in that season ; and then a thaw so 
soon succeeds, that in the space of ten years the ice may not 
be strong enough to bear a man." (See an Account of the 
Weather and Diseases of South Carolina, by Lionel Chal- 
mers, M. D. vol. i. p. 23.) 

It is owing to these differences between the same seasons 
that, while the annual mean temperature of Charleston is es- 
timated at 66 degrees, (according to a Register kept by Dr. 
Chalmers, for ten years,) that of Philadelphia is reckoned at 
only 52" 5, and that of New England at from 50 to 48 de- 
grees ; and from these differences there will also result cer- 
tain physical effects in the inhabitants, which claim a particu- 
lar attention. In the southern states, where the summer be- 
gins earlier, and the autumn lasts longer, than in the higher 
latitudes, the inhabitants have to endure a long continuation 
of hot weather ; and in doing this, they at length acquire, in 
a considerable degree, the power of supporting heat ; of which 
power they lose but a small portion during the winter, because 
the frosts being there neither frequent nor of long continu- 
ance, their bodies accommodate themselves with ease to the 
mild temperature of that season, and there are few occasions 
in the course of it, when those greater efforts are required 
which the body is obliged to make whenever it has to resist a 
severe degree of cold, and, by the frequent making of which, 
it seems to be always rendered less able afterwards to sustain 
heat. Hence it results, that the southern inhabitants can 

* Geography of the United States of America, hv Jed. Morse, A. M. 4to. p. 426. 



188 

scarcely be affected by the moderate warmth of the ensuing 
spring, or the gradual increase of temperature, during that 
season ; and that they will be able to support the subsequent 
heats of the summer, with little or no morbid excitement. 
But, in the northern states, the comparatively short term of 
the hot season does not there permit the inhabitants to acquire 
an equal share of the power of supporting heat with their fel- 
low citizens in the south : and that share of it which they do 
acquire, is much diminished afterwards, or, perhaps, wholly 
lost, during the long and rigorous winter of those latitudes, 
when great and continued exertions of the animal powers he- 
come necessary that they may be enabled to sustain so cold a 
temperature. It is, therefore, obvious, that on the return of 
the summer, the transition which the inhabitants of the north- 
ern states will then have made, from extreme cold to exces- 
sive heat, must be the means of causing a much higher degree 
of excitement in them than will ever be produced in those of 
the southern states, for the reasons before given, and, on in- 
curring to facts, it appears from them that when the yellow 
fever has raged over this part of the world, (which seems 
never to have happened except when summers have been ex- 
ceedingly hot) the degrees in which the citizens of the diffe- 
rent towns of America were liable to the disorder, correspond 
exactly with the power of supporting heat confen*ed on them 
habitually by their respective climates. Accordingly, the 
citizens of Savannah and Charleston are almost equally 
empt from the yellow fever with Creoles, as I had the oppor- 
tunity of witnessing in both places in the year 1797. But, 
that this may not seem a mere assertion of mine. I shall beg 
permission to quote the testimony of Dr. Ramsa\ , of Charles- 
ton. This very respectable physician, after mentioning that 
the yellow fever had occurred there in seven out of nine of 
the last years, of the last century, and had continued in all 
those years from the month of July to the following Novem- 
beiv distinctly says, that, M with very few exceptions ^chiefly 



189 

children,) it exclusively fell on strangers to the air of Charles- 
ton."* 

The situation of Norfolk, in Virginia, is nearly midway 
between Charleston and Philadelphia, and its climate corres- 
ponds with its situation, being colder than that of the former 
city, but warmer than that of the latter. The yellow fever 
has frequently appeared there ; and, according to the testi- 
mony of Drs. Taylor and Hansford, (residents in that town) 
it has, at least, " in its malignant form, always originated on 
the (banks of the) river, or on low, new-made grounds, and in 
houses built on the docks. In all cases, it begins with stran- 
gers and new settlers, affecting every one in proportion to his 
time of residence, and leaving the old inhabitants not wholly 
exempt, yet proof against its destroying power." " Persons 
from higher latitudes often fall victims, but with European 
strangers, the fever was generally uncontrollable." (New- 
Yoi*k Medical Repository, vol. iv. p. 205, 6.) This account 
is strongly confirmed by Doctors Seldon and Whitehead, of 
the same place, in a well-written statement, which will be in- 
troduced hereafter. 

With regard to the towns of the more northern states, as 
Baltimore, Wilmington, Philadelphia, New- York, New-Lon- 
don, Boston, &c. there is ample proof that the inhabitants of 
each of them become more subject to the disease, as their situ- 
ation approaches to the north : for, it is but too evident, from 

* See Dr. Ramsay's Review of the Improvements, &c in Medicine, in the eighteenth 
century, read on the fii-st day of the nineteenth century, before the .Medical Society 
of South Carolina, p. 39. If this testimony, delivered before so many persons ac- 
quainted with its truth or falsehood, and never, as I believe, controverted by any 
one, could need confirmation, I might adduce that of the late governor of that Slate 
(Mr. Drayton) who, in his Review of South Carolina, printed at Charleston, in 1802, 
has made the following statement, at pages 27 and 28. " The Typhus icteroides or 
putrid bilious, or Yellow Fever, is, however, particularly local to Charleston ; and is 
not known to have originated in the countiy. To the natives, and long- inhabitants of 
this city it has not yet been injurious. But those who come from the country, during 
the autumnal season, or who have not been accustomed to spend the fall months in 
Charleston, or to foreigners at their first arrival, it is particularly dreadful, and many 
are those who full victims to its fatal influence." 



190 

the registers of the deaths, reports of the Boards of Health, 
and other authentic documents, which have been made public, 
that whenever the epidemic has broken out in those places, 
the mortality has not been there almost wholly confined to 
strangers, as in the southern towns ; but, on the contrary, 
that a very large majority of those who had the fever and 
died, consisted of fixed residents. This lias been especially the 
case in the four last mentioned towns, the citizens of which 
seem to have been almost as readily attacked and carried off 
by the disorder, as foreigners even from the north of Europe, 
though persons lately arrived from hotter climates generally 
escaped it. In like manner, the official account of the yellow 
fever at Cadiz, in 1800, asserts, that, "persons lately ar- 
rived in that city from the West Indies, did not suffer an at- 
tack of the epidemic," while those persons who had come 
" from Canada, and other northern countries/' were very lia- 
ble to the disease. 

Thus, by attending to the usual and necessary effects of 
heat on the human frame, under different circumstances of 
climate, it will be perceived, that we obtain a simple explana- 
tion of some of the most important general facts with which 
the occurrence of the Yellow Fever is connected. An addi- 
tional proof, that the security from that disease is principally 
derived from the ability to endure great heat,* without its 
I 

* The natural ability to endure great heat varies not only among diffei-ent r 
men, but also among individuals of the same race, though living constantly in the 
same situations, e. g light and red-haired people with very white skins, universally 
bear cold better, and are more incommoded by heat, than the black-haired with dark 
skins. Hut, besides these constitutional differences, there is another, which depends 
more immediately upon the established habit of generating cerfctin degrees or portions 
of animal heat, for the purpose of keeping the temperature of the body at the h 
fill standard ; and it is this difference extending generally to all torts of persons, tltat 
is now more immediately in my contemplation ; though its effects arc liable to be 
augmented or diminished by the constitutional peculiarities of individuals, and of the 
several races among mankind. Probably the power of habit may also, as Lancisi, and 
others, have believed, extend so far as to diminish the morbid influei'Ce of marsh 
miasmata upon persons who, from their birth, or, for a considerable number of J 
have been more or less exposed to their impressions, at least there are far;- 



191 

causing any considerable derangement in the animal (econo- 
my, is, that this security continues only so long as this abi- 
lity continues : for, if the inhabitants of warm climates re- 
move, for a few years, into cold countries, and afterwards 
return, they are then found to be liable to the fever. So, 
likewise, the refugees from the French West-Indian islands, 
in America, who, as was before observed, at first universally 
escaped the disorder, were frequently attacked by it after they 
had passed three or four winters in that country. Another 
important proof of the same nature, is the more frequent ap- 
pearance, and the greater severity of the Yellow Fever, in 
populous cities, than in the country : circumstances which it is 
natural that we should expect, when we recollect the various 
causes which contribute to warm the atmosphere in towns, 
and which do not exist out of them ; such, for example, as 
the absorption of solar heat by, and the reflection of it from 
the walls of houses, and the pavements of streets, the assem- 
blage of a number of living bodies ; the many fires kept up 
for domestic purposes, and the obstruction to the circulation 
of the air, occasioned by large collections of houses. By a 
combination of these causes, the temperature of the atmos- 
phere, in a large town, may be raised to a degree sufficient 
to produce the Yellow Fever within it, while that of the neigh- 
bouring country may not be high enough for its rural exist- 
ence.! There is an interesting fact connected with this last, 

posed facts, which support this belief. In regard to individuals, who, by long residence 
in cold climates, have become habituated to the generation of large portions of animal 
heat, it must be remembered, that the cold, which forces this habit upon them, will 
naturally produce in them a considerable rigidity and strength of fibres, with an inflam- 
matory diathesis, and that, when they remove directly to an intertropical situation, 
they will commonly carry with them a great accumulation of excitability, which, co- 
operating with the established habit of generating much animal heat there, may 
readily produce in them a most aggravated and violent form of fever, from a cause or 
causes which, in the relaxed systems, and with the diminished excitability of persons 
who have resided many years in hot climates, would only produce an intermittent or 
remittent. 

f Dr. Caldwell, in his Medical and Physical Memoirs, says, « Philadelphia, like 
every other large and populous city, possesses a factitious climate of its own, different 



192 

which ought not to be omitted. Dr. Ramsay, whom I have 
before quoted, after mentioning, that persons coming to 
Charleston from the higher northern latitudes of Europe and 
America, had been most subject to this disease, and had most 
rarely survived it, states, that " the inhabitants of the coun- 
try parts of South Carolina had little better chance of escap- 
ing it altogether, if they came into the city, or of recovering, 
when attacked f* but, considering that, according to Dr. 
Chalmers, the atmosphere is always from 10° to 15 hotter in 
Charleston than in the country, where it frequently freezes 
pretty hard, whilst, at the same time, no signs of ice appeal' 
in town, we shall instantly perceive that the people from the 
country are susceptible to the fever in the same degree, when 
compared with those of the town, as persons coming from 
towns considerably to the north of Charleston ; and it is also 
plain, that the same reasoning is applicable to the country 
people residing near most other large towns.f 



from the climate of the surrounding country." " The summer climate of Philadel- 
phia, and of other large cities, similarly situated, is an artificial torrid zone, in which 
the thermometer rises from four to six degrees higher than it does at the distance of a 
few miles in the country." 

By a very accurate account of the state and variations of two Register thermometers 
kept, one in London, and the other at Newick Park, in Sussex, in U»e winter of 1806-7, 
it appears, that, though the latter place is thirty -five geographical miles south of the 
former, yet the weather was commonly between four and five degrees colder at 
Newick Park than it was at the same hours and days in London. This account was given 
to me by the late Mr. Tiberius Cavallo, whose care and love of truth are well known. 

* We are informed by Spanish and other writers, particularly Humboldt, that this 
also happens at Lavera Cruz, where the Yellow Fever exclusively attacks strangers 
from more temperate northern climates, or persons coming to town, from higher and 
cooler situations in the country ; and this is also the case in Jamaica, &c. See Dr. 
Dancer's Medical Assistant ; or, Jamaica Practice of Physic, p. S* 

f The younger JWichaux, who, under the auspices of the French government, made 
a second voyage to the United States of America in 1801, tells us that he landed at 
Charleston, in South Carolina, on the 9th of October in that year, contrary to the ad- 
vice which was given him, and which was followed by the other passengers, of retiring 
to Sullivan's Island until the appearance of frost ; that he was soon after attacked by 
the Yellow Fever, which, in that very year, proved fatal to eight-tenths of all the 
strangers in that city, and which had nearly cost him his life. He observes, that this 
disease varies in the degrees of its intensity every year, and that the inhabitants of 



193 

If after all these facts, which are not less in conformity 
with the simplest laws of nature, than in harmony with each 
other, and which appear to me to form a chain of convincing 
and even decisive evidence, any further puoof could be desired, 
concerning the uniform correspondence of the exemption from 
the Yellow Fever, with the power of supporting heat, it is 
afforded by the knowledge of the various degrees in which ne- 
groes are susceptible to the disease under different circum- 
stances. 

The annual mean temperature of those parts of Africa, 
which are peopled by the various tribes of negroes, is, per- 
haps, no where less than 84° upon the coast, and it is, proba- 
bly, several degrees higher in the interior. This, however, 
is only to be understood of the temperature in the shade, or in 
the coolest places, and does not indicate the greatest heat 
which the natives of Africa can sustain,- nor even that 
which they may be said to bear habitually : for it will be 
recollected, that they pass a great part of the day in the 
open air,- and as their bodies are generally naked, ex- 
cept about the middle, they are fully exposed to the ac- 
tion of the sun's rays, the direct heat of which has been esti- 
mated, and, I believe, without exaggeration, to vary from 
1 20 to 160°, while the thermometer in the shade marks from 
85 to 110°. But the bodies of blacks, and especially their 
colour,* are so admirably adapted for supporting, or rather for 

Charleston are but little affected by it But, that those who live in the higlier parts of 
that state, at the distance of two or three hundred miles, and who came to Charleston 
during the four mouths, in which the Yellow Fever commonly prevails, are as liable to 
be attacked by it as strangers ; and, therefore, (he adds) all intercourse between the 
country and city is suspended for one-third of the year, excepting that of a few white 
persons who, from necessity, go to the latter, always taking care, however, not to 
sleep there ; and that of negroes bringing provisions, who are but little subject to the 
disease. See Voyage a L'Ouest des Monts Alleghanys, &c. par F. A. Michaux, 
M. D. &c. A Paris, 1804. p. 2, 3, 4, and 5. This account accords with the information 
which I have received from medical and other gentlemen of unquestionable veracity/ 
and well acquainted with Charleston. 

* See in the Philosophical Transactions of the Royal Society, for 1804, " An Enquiry 
Concerning the Nature of Heat," &c. in which the effect of a black skin, or of a black 
external surface, in promoting the coolmg- of bodies, is proved by experiment See 
also Mr. John Leslie's " Experimental Inquiry into the Nature and Propagation of 
Heat. 

25 






194 

resisting, the intense heat in which they are naturally destin- 
ed to live, that, at all times, their skins feel cool to the touch 
of an European. Endowed with these physical peculiarities, 
they are there so little subject to fevers, that the disease does 
not appear to have a distinct and peculiar name in any of their 
languages. Sometimes, indeed, they are affected by slight 
febrile indispositions ; but these as Dr. Winterbottom ob- 
serves, in his Account of the Native Africans of Sierra 
Leone, (vol. II. p. 13,) are seldom of longer duration than 
twenty-four hours, and they are usually the sequel of some 
debauch, and especially of that excessive intemperance, in 
which they indulge at the funerals of their friends.* 

In the West-Indian Colonies, blacks are still so far exempt 
from febrile disorders, that even intermittents, the mildest of 
fevers, seldom occur among those negroes who are employed to 
labour in the fields, and they do not often even among those 
who have diminished their power of enduring heat by wearing 
clothes, and by living with peculiar indulgence in the cooler 
dwellings, provided for the comfort of Europeans.! Nearly 

* Vitruvius seems to have been the first who noticed a difference in regard to the 
predisposition to fevers, and the po ver of supporting them with fortitude, between the 
inhabitants of cold and those of hot climates. He says, Lib. vi. cap 1. " Sub Septen- 
trionibus njitriuntur gentes immanibus corporibus, candidis coloribus, directo capillo Sc 
rufo, oculis caesiis, sanguine multo, quoniam ab humoris plenitate coelique refrigeratioui- 
bus sunt confirmati. Qui autem sunt proximi ad axem meridianum subject ique sol is 
cursui, brevioribus corporibus, colore fusco, crispo capillo, oculis nigris, cruribus in- 
validis, sanguine exigus, soils impetu perficiuntur ,• itaque etiam propter sanguinis 
exiguitatem timidio es sunt ferro resistere, sed ordores ac febres siiffenint sine timore, 
quod nutrita sunt eorum membra cum fervore ; itaque corpora quae nascuntur sub 
septentrione a febri sunt timidiora & imbeciUa, sanguinis autem abundantia ferro re- 
sistunt sine timore." 

f Dr. Mosely, in his Treatise on Tropical Diseases, (3d edit, ) p. 146, asserts, that 
none of the Europeans sent in 1780 on the expedition against St. Juan, " retained their 
health above sixteen days, and not more than three hundred ever returned; and those 
chiefly in a miserable condition. It was otherwise with the negroes who were em- 
ployed on this occasion ; a very few of them were ill, and the remainder of them 
returned to Jamaica in as good health as they went from it." He adds, it was the 
same at the taking of Fort Omoa from the Spaniards. ■ On that expedition half the 
Europeans who landed died in six weeks. But very few negroes ; and not one of 
two hundred that were African bom. The Creole negroes did not bear hardships so 



195 

the same may be said of the negroes belonging to plantations 
of rice, in the Floridas, and the State of Georgia, which, it is 
well known, are abnost always made on swampy grounds, 
because they require to be overflowed at certain times : on the 
rice plantations, in the Carolinas, however, blacks some- 
times have intermittent and remittent fevers, though neither 
so frequently, nor so severely, as the whites, who reside on 
the same spots ; but they seldom or never have the epidemic 
Yellow Fever, as Drs. Moultrie, Lining, and Chalmers, of 
Charleston, have formerly attested ; and, as subsequent expe- 
rience has sufficiently proved. In Virginia, however, and in 
Maryland, negroes have occasionally been attacked by the 
latter disorder, and they are found to be still more subject to 
it in the states which are to the north of these, as Delaware, 
Pennsylvania, New-York, and New England. Dr. Rush 
says, that he was led to believe, from various publications on 
the Yellow Fever, that the blacks would escape it, while it 
was epidemic at Philadelphia, in 1793 : but, as he candidly 
confesses, it was not long before he was convinced of his er- 
ror, for it seems that, although the disease was commonly 
lighter in them than in white people, " yet many of them died 
with it," at that unfortunate period, and many more of them 
have also died of it, in that city, during the epidemics of the 

well." This accords with Dr. Dancer's account of that expedition ; but he adds, that 
though the Mosquito Indians, who were sent upon it, suffered from fevers, and still 
more from fluxes, the Indians of Cape Gracios a Dios, who have an admixture of ne- 
gro blood, suffered less than any other Indians. The great and almost peculiar exemp- 
tion from fevers, enjoyed by the black natives of Africa, is also asserted by M. Bour- 
geois, in his Dissertation " Sur les Maladies de St. Domingue," printed in a volume, 
entitled " Voyages Interessans Dans Differentes Colonies. " p. 417, where he says, 
"Les Negres de la Cote," (d'Afrique) " et les Negres Creoles font presque en ce 
genre deux especes differentes; car ceuxci, quoique d 'une complexion forte et vigo- 
reuse dont n'approchent point nos Creoles blancs, ont pourtant plus fr6quement que 
les autres la fievre et les diverses sortes de maladies auxquelles les blancs paraissent 
specialement affectes. Les negres nouveaux, qu'on nous mene d'Afrique, sontd'un 
temperament plusdur;" "Jamais les negres nsfl'saux ne paient, en arrivant dans la 
colonie,* ce qu'on y appelle le tribute 



196 

following years.* Thus we find that negroes, by long resi- 
dence in cool or temperate situations, become susceptible to 
the Yellow Fever, from the same physical causes as whites ; 
though always in an inferior degree to the latter, under simi- 
lar circumstances : and, to complete the analogy, the) are, 
like whites, very liable to it, when, after having passed some 
years in cold countries, they are carried back to hot climates. 
This has been sufficiently proved by the results of the three 
great importations of blacks into Sierra Leone, which have 
been made within a few years ; the first from this country, in 
1787, and the others from Halifax, (Nova Scotia) in 1792, 
and in 1800. Upon each of these occasions, a considerable 
number of the blacks were seized with fevers, and many of 
them died ; but the proportion both of sickness and of mortality, 
was much smaller in them than in the whites, who were sent 
out at the same time to superintend or assist the new 
tlers.| 

In the preceding enquiries, I have attempted to ascertain 
and describe the uniform course of nature in regard to the 
formation and operation of miasmata, and in regard to the 
effects of heat on the human body ; and, if the principles 
which I have been led, be not erroneous, it will, I think, be 
admitted, that the joint influence of marsh miasmata, and of 
an atmosphere unusually and sufficiently heated upon persons 
habituated to a cold or temperate climate, is, of itself, fully 
capable of causing an epidemic Yellow Fever, exactly resem- 



* These negroes had many of them heen bom in Pennsylvania, and the others must 
have lived in that part of America, long enough to lose a great part of their constitu- 
tional peculiarities ; for no importation of negroes had been permitted by the laws of 
that state during the preceding ten years. 

f I have now before me a statement of the progress, extent, and decline of the 
sickness and mortality vhich attended each of these importations of negroes, compared 
•with what befel the whites at Sierra Leone, in these respects, made from official docu- 
ments, reports, and correspondence which I was permitted to inspect. The results ac- 
cord with, and fully confirm, the principles and conclusions here advanced : but I ab- 
stain from printing this statement, as I had intended, because it may not be (nought; 
Sufficiently interesting for the space it would occupy. 



197 

bling that which has committed such ravages in the West In- 
dies, the United States of America, and the South of Europe ; 
I mean a disorder which does not recur but after very irregu- 
lar intervals, and with degrees of severity, varying at each 
recurrence, and whicli uniformly attacks with violence per- 
sons of a certain physical constitution, while it allows other 
persons to escape with a mild, and often without any disease. 
It will, moreover, he perceived from the same principles, that 
the influence of these causes, when it is sufficiently powerful 
to produce an epidemic Yellow Fever, can only produce one 
of the above description. With the assistance of those princi- 
ples, it will be easy to understand by what simple means the 
atmosphere of a town, in certain climates, may become, and 
must occasionally become, so vitiated, at least in some parts, 
and so productive of dangerous fevers, as justly to claim the 
appellation of an epidemic constitution, and this, without re- 
quiring the smallest aid from contagion, or from those occult 
causes and supernatural agencies, to which writers have had 
recourse, when they undertook to explain the meaning of that 
term ; without admitting, in short, the operation of a single 
agent, of whose actual existence there is not as complete evi- 
dence as we can possibly have of the existence of any agents 
in physical cases.* And, however few the causes may appear 

* Sydenham appears not to have known, or even suspected, the influence of marsh 
effluvia as the cause of intermitting or remitting fevers, though Hippocrates, Galen, Var- 
ro, Columella, Palladius, Virtruvius, Dkxlorus Siculus, DionysiusHalicarnassensis,Strabo, 
and others, had observed, 'and very distinctly mentioned, the insalubrity of stagnant wa- 
ters, swamps, &c. Avithout, indeed, properly understanding the ways or means by which 
their morbid effects v ere produced. Sydenham, after telling us that he had, in vain, 
laboured to discover why seasons, apparently similar to each other, were accompanied 
or followed by very dissimilar effects, in regard to health and diseases, adds, " Ita enim 
se res habet ; Varise sunt nempe annorum constitutiones, quae neque calori, neque fri- 
gori, non sicco humidov© ortumsuum debent, sed ab oculta potius et inexplicabili qua- 
darn alter atione in ipsis term visceribus pendent, unde aer ejus modi effluviis contami- 
natur, qua humana corpora huic aut illi morbo addicunt determinantque." (De 
Morb. Epid. c. ii. p. 41.) Thus he manifestly overlooked the materials, the situations, 
and the conditions of the atmosphere (in regard to heat and moisture) whieh contribute 
to the production of marsh miasma, and sought for occult and inexplicable changes in 
the very bowels of the earth, whence he supposed effluvia to issue, contaminating the 



198 

to be, by which I have endeavoured to shew, that the various 
gradations of severity, observed in fevers, which originate 
from miasmata, are produced, let it only be recollected that 
(as every new discovery demonstrates,) nature accomplishes 
all her wonders, not by employing a multitude of agents, but 
by merely varying the combinations of a few simple means. 

That fevers, occasioned by marsh effluvia, often prevail 
epidemically, is a fact which has been so frequently observed 
and attested, that any proof of it would be superfluous.* It 
ought, however, to be remarked, that the epidemical pro- 
gress of these fevers often very much resembles that of a dis- 

atmosphere, and subjecting the body to various diseases. These notions he repeat? 
in other places : and, when he attempts to assign a reason for the prevalence of inter- 
mittents epidemically in autumn, he seems to think, that so far as they resulted from ■ 
change of air, such change was accidental. 

* " Intermittentes febres sapius epidemics grassanrur quam alii morbi. Vaa 
Swieten, Tom. ii. p. 2C4 sect C59. 

"Certa Homanorum ohservatione constat, postingentes Tyberis ' inundationes oriri 
febres epidemicas in urbe valde graves ac pernieiosas." Baglivi Opera Omnia, p. 51. 

Sir John Piingle (Diseases of the Army, p. 192) has justly supposed tbeffteen 
plagues, mentioned by Livy, as having occurred at Home before the year, (Vrb. Cond.) 
59 to have been so many destructive epidemics produced by exhalations from Uie ad- 
joining marshes ; and I may add from the low grounds, at tlte bottom of its hills, espe~ 
daily those along the Tiber, where marsh fevers appear to have greatly prevailed, from 
the earliest periods of its history. These seem to have been most commonly of the 
semitertian form ; as Galen (de Temperam. lib, ii.) represents the Hemitrita as being 
the common epidemic of Rome. 

" Les maladies epidemiques ou populaires sont la source, presqu' exclusive, des mor- 
talites." " Le i-approchement des observations sur les maladies populaires demontre 
leur parfaite identite. En effect, ces maladies sont les memes dans tous les pays, tous 
les climats, &c. elles sont dans l'abord, de la classe des febres remittentes & intermit- 
tentes', elles eprouvent seulment quelques varietes qui ne sont pas plus considerables 
d'un pays a un autre, que d'un individu a l'autre dans le meme pays." Precis sur les 
maladies epidemiques qui sont les sources de la mortalite parmi les gens de guerre, 
les gens de Mer, &c. (a Paris, 1787) Par M. Retz, Medecin ordinaire du Roi, ci-de- 
vant medecin ordinaire des Hopitaux de la Marine, a Rochefort. Not to extend these 
references unnecessarily, I will only add, that Lancisi, in his second book De Nox. Pa- 
lud. Effluv. has given distinct histories of five epidemics, from mavsh miasmata, which, 
in his time, had greatly infested the Roman or ecclesiastical territory. He writes 
" Daturus autem hoc secundo libro, quinque historias insignium epidemiarum, qur prse 
aliis nostra ajtate propter palustres aquas, varia Ecclesiastics ditioois toca parvagatr 
sunt/'&c. p. 188, &e. 



199 

ease propagated from person to person by contagion, with 
only this exception, that it is frequently more rapid ; a cir- 
cumstance which has, however, been commonly overlooked 
by indiscriminating observers. Upon such occasions, those 
persons in each family who happen to be most exposed to 
marsh miasmata, and most susceptible of their effects, will 
be first attacked ; those who are exposed and susceptible, in 
the next degree, will be the next attacked, and so on in suc- 
cession. 

This, which is the natural course of a disorder arising from 
that cause, has very commonly induced a belief, especially in 
times of general alarm, that those who first sickened, had 
communicated the fever to the next, and these to others suc- 
cessively ; and, consequently, that the fever was contagious. 
And, in this way, even Stahl, with all his good sense, and dis- 
cernment was so far misled, that, though justly convinced that 
regular sporadic inter mittents were destitute of any contagious 
property, he strangely believed them to change their nature, 
and acquire that property merely by attacking great numbers 
of persons, in the same season and neighbourhood.* 

It is not my intention here to notice all the supposed varie- 
ties of marsh fever, which have been minutely described by 
Torti and others, with little or no practical advantage. It 
will be sufficient for my purpose to observe, that- the forms 
most prevalent in hot climates seem to be derived from the 
tertian, variously complicated, or compounded; and that of 
these, the form which was called Hemitritaus, or semitertian, 
by Celsus, (the Hemitriteon of the Greeks) and to which 
Lind, Sauvage, and many other modern writers, have ap- 
plied the name of Tertiana Duplex, or double tertian, is ge- 
nerally the most malignant and destructive of all the marsh 
fevers in hot climates and seasons ; and more especially when, 

* " Quid notius quam febris tertiana ? quid certius quam quod ilia legitima, longti 
absit a contagiosa communicatione ? quid vero familiaril&s quam ut etiam epidemici, 
imo contagiosi grassari obserretur ?" Stahlius de Febribus, a Goez. p. 29. 



200 

by great excitement* from the causes already mentioned, 
the paroxysms are so much prolonged and crowded upon 
each other, as to appear like a continual fever, or, at least, 
to leave no sensible remission during the first thirty-six, 
forty-eight, sixty, or seventy-two hours ; as commonly hap- 
pens in what is called yellow feverA This seems to be 
the " irregular semitertian" of Dr. Fordyce, in which, ac- 
cording to his Statement, (4th Dissert, p. 61, &c.) "the 
hot fit is frequently prolonged, so as to leave no other 
mark of an intermittent to distinguish it from a continued fe- 
ver, excepting the exacerbations not taking effect in the even- 
ing." He concludes, however, that it is not a continued fe- 
ver, from " an agreement of all those who have had, or hawt 
seen, or have treated the disease, in the following obsei 
tion." " It happens often, that a patient apparently becomes 
greatly relieved, and appears in a state as if he were recover- 
ing, when, all at once, a fresh attack takes place, and car- 
ries him off." This, he adds, " is the most form idable dis- 
ease incident to mankind. It has frequently been called the 
plague.'' 

Alexander seems, as Dr. Fordyce has observed, to have 
died of an irregular semitertian, caught by surveying the 
marshes adjoining the river Euphrates, to ascertain the 
means by. which they might be most advantageously drained. 
The daily reports or bulletins, respecting the progress of his 
disorder, have been preserved and transmitted to us by 
Arrian. 

* Dr. Fordyce, at p. 4G of his fourth Dissertation, mentions as a niischievou- 
of strong arterial action, or general inflammation in intermitting fevers, its prolonging the 
hot fit, so as to render the intermissions imperfect, ami converting an intermittent into 
a continual fever. 

The late Captain Bernard Romans, who was a man of observation, as well as ve- 
racity, says, in his Natural History of East and West Florida, (p. 258) that the inter- 
mittent fever, in that part of America, " attacks people iu the same form as the con- 
tinued fever; the first fit frequently lasting three dins, without intermission." 

f Dr. Gillespie says of the Yellow Fever among the West India Lew ard islands, in 
1794, 5, and 6, that it might " be called a remittent fever, or tertiana coirtinua, as 
there were always remissions in cases terminating well/'— and, " as the epidemic insen- 
sibly changed into the form of a tertian fever." 



201 



In thus connecting what is called yellow fever with inter- 
mittents and remittents, as being only an aggravation of the 
latter, and, consequently, as being devoid of contagion, I 
feel myself supported by great authorities, and by facts, as 
decisive as they are indisputable. There are, however, per- 
sons of considerable eminence as medical men, who strongly 
contest the derivation of yellow fever from marsh miasmata, 
asserting that it has no relation to marsh fevers, but is exclu- 
sively produced and propagated by a peculiar contagion. This 
opinion seems to have been very extensively and inconside- 
rately adopted, especially in Europe ; and as a demonstra- 
tion of its fallacy, if it be, as I think, fallacious, must con- 
duce to the best interests of mankind, I propose, in the next 
or fourth part of this Essay, to exhibit a summary statement 
of the principal facts regarding the history of yellow fever, 
in different parts of Europe and America, and regarding its 
manifest connexion with fevers notoriously originating from 
marsh effluvia ; confidently believing that this statement, (sup- 
ported by ample proofs,) with the conclusions fairly deducible 
from it, will completely remove all uncertainty or doubt from 
the mind of every impartial and judicious reader, who shall 
bestow proper consideration on the subject. 

All this, however, will not accomplish my undertaking, be- 
cause there are persons, particularly Dr. Chisholm, who ad- 
mit that yellow fever, as it existed in the West Indies, previ- 
ously to the year 1793, was derived from marsh miasmata, 

and destitute of contagion, but assert, that a " nova pestis, a 
peculiar, original, foreign pestilence, recently generated, and 

utterly unknown before, endued with a new and distinct cha- 
racter, possessing new powers of devastation, and capable of 
propagating itself throughout the world," was introduced by 

the ship Hankey, into Grenada, on the 19th of February, 

1793. See Dr. Chisholm's Letter to Dr. Haygarth, p. 217, 

and 218. 

From Grenada, Dr. Chisholm states this new pestilence to 

have been propagated over not only a great part of the West 

26 



202 



Indies and North America, but also to Ireland, Cadiz, Ma- 
laga, Carthagena, and other places in Spain, and also to 
Gibraltar, and in some of these places, to have supplanted 
the yellow fever, properly so called. However strange *M 
chimerical this recent generation of a new plague may appear, 
now that miracles are believed to have ceased, it has been, in 
some degree, admitted and believed by a considerable num- 
ber of persons, among whom are several for whose judgment, 
in other respects, I feel great deference, and, as the purpose 
of this Essay will not be fully attained, unless it can be made 
evident that there is no reasonable foundation for believing 
that the supposed nova pestis was essentially or specifically 
different from the common yellow fever, of the AVest Indies, I 
shall undertake to perform this service, also, to what 1 think 
the cause of truth, in a separate Appendix, No. r. 

In addition to all this, I must observe, that some physi- 
cians, of great respectability, appear to have believed, that 
the yellow fever is either commonly or occasionally a sort of 
hybrid or mongrel disease, resulting from an application of 
the contagion of typhus fever, to persons who have been pre- 
viously exposed to the impressions of marsh eflluvia, or from 
the action of the latter, upon persons who have before im- 
bibed the former. As either of these causes is undoubtedly 
capable of producing fever alone, in suitable circumstun 
we may reasonably suppose, that an effect equally morbid 
would result from their joint operation, unless there be some- 
thing in their natures, which disposes them rather to counter- 
act than assist each other. But of this I believe nothing is 
known ; and, therefore, I see no decisive objection to the pro- 
duction or existence of a fever, from the united action of con- 
tagion and of miasmata; though there is not, within my 
knowledge, any fact which either proves or renders it very 
probable, that any such hybrid production ever has taken 
place ; and, in general, it is not philosophical, or proper, to 
assign two causes for an effect which may be produced by tnc 
If, however, a mixed disease were producible by these causes. 



203 

I should expect to find it at, or in the neighbourhood of Ports- 
mouth, rather than in the West Indies ; because, at the for- 
mer, persons arc often exposed simultaneously to the action 
of both of these causes, which can rarely if ever happen in the 
West Indies, where the heat soon extinguishes the contagion 
of typhus fever, and would, probably, hinder the propagation 
of any hybrid disease, like that under consideration, if it could 
be either produced in, or conveyed to,, that part of America : 
Whereas, such a disease, occurring at Portsmouth, in any 
season when the temperature is moderate, might, from its 
affinity with typhus, reproduce itself in persons who had been 
exposed to the exhalations of marshes, or in the absence of 
such persons, it might occasion a pure typhus fever only. 

Sir John Pringle has supposed, (Diseases of the Army, p. 
188,) that the Hungarian fever, described by 861111611118,* 
without his having any personal knowledge of it, and which 
is said to have spread widely in the year 1566, (as was be- 
lieved by contagion) must have been " a compound of our au- 
tumnal and hospital fever," or the hybrid disease in question ; 
and Dr. Lempriere, though he represents typhus fever as a 
rare disease in the West Indies, (see vol. 2d of Diseases of the 
Army in Jamaica, p. 25, 32, 33, &c.) yet at page 38 and 39, 
of the same volume, he treats of a fever at Jamaica, which he 
supposes to have been a typhus combined with yellow fever, 
or modified by the causes producing yellow fever: and, at 
page 81, he mentions a "variety of yellow fever," attacking 
sailors and soldiers almost exclusively, and with great mor- 



* Medical writers have often described fevei-s as being contagious with so little con- 
sideration or foundation, that we may reasonably suspect the spreading of this fever, to 
have been merely an effect of marsh miasmata, imbibed by the imperial troops in the 
marshes of Hungary, and producing their morbid effects, some montlis after, when the 
army had separated and removed into other situations, as happened with the British 
troops who were lately at Walcheren. If this were the case instead of the mixed 
disease supposed by Sir John Pringle, the fever in question could not have specifically 
differed from the marsh fevers which so frequently prevail in Hungary, viz. the Mor- 
bus Hungaricus Lang. Lemb. I. 1. cp. 4, the febris Hungarica seu castrensis of Junck- 
er, the amphimerina Hungarica of Sauvage, &c. 



204 

tality, which he supposes to have been a combination of the 
tropical endemic and of typhus fever. 

Dr. Chisholm, also, in some parts of his account of the 
supposed New Pestilence at Grenada, appears (as far as I am 
capable of discovering his meaning) to imagine that it was 
generated by a sort of conjunction of contagion, with marsh 
miasmata, as I shall have occasion to notice in my Appendix, 
No. 7. And, finally, Dr. Blane also appeal's to connect yel- 
low fever with the contagion of typhus, at least when it pre- 
vails extensively. He says, (p. 609 of his Observations on 
the Diseases of Seamen.) " After laying together, and con- 
sidering fully all the facts relating to this subject, it appears 
to me that the yellow fever cannot be produced, but in a sea- 
son or climate, in which the heat of the atmosphere is pretty 
uniformly, for a length of time, above the 80th degree of 
Fahrenheit's thermometer; that, under the influence of this 
heat, Europeans newly arrived, and more especially in cir- 
cumstances of intemperance, or fatigue in the sun, may be 
subject to it in many instances ; but that it has usually become 
general only by the previous influence of that infection which 
produces the jail, hospital, or ship fever, or from the influence 
of putrid exhalations ; and that, when so produced, it con- 
tinues itself by infection. It would be too tedious to enume- 
rate the multiplied proofs of this, which have occurred to me 
in my connexion with the public service.'' But, though Dr. 
Blane did not think it expedient, on this occasion, to favour 
his readers with a statement of the M multiplied proofs" in 
support of his opinion, which had occurred to himself, and 
which, by that circumstance, would have been highly impor- 
tant, he seems to have afterwards intended to make a full 
compensation for this omission, in his letter to Rufus King, 
Esq. (late minister plenipotentiary from the United States of 
America,) in which, to justify his belief of the contagious na- 
ture of the yellow fever, he refers to, and strongly relies u}>on, 
the events which followed the capture " of two French armed 
ships from Gaudaloupe," by the^ Thetis and Hussar friga 



205 

in May, 1795, on the coast of America. This transaction, 
though unfortunately, he had no personal knowledge of it, 
Dr. Blane, selects and holds up to Mr. King, and the public, 
as affording " a conviction of the reality of infection as irre- 
sistible, as volumes of argument :" and he afterwards refers 
to it, in his letter to Baron Jacobi, the Prussian minister, as 
affording decisive evidence on the subject. I was, therefore, 
induced by my particular regard for the writer of that letter, 
and by the great estimation in which his judgment and expe- 
rience are deservedly held, to enter upon a minute investiga- 
tion of this transaction, which I should not have done had it 
been brought forward on less respectable authority. The re- 
sults of that investigation will be found in my eighth and last 
appendix, and they will, I am persuaded, sufficiently prove 
that yellow fever was not the disease supposed to have mani- 
fested contagious properties on that occasion. Having thus, 
as I hope, encountered and removed all the difficulties which 
were opposed to the adoption of my own conclusions on this 
subject, I shall proceed to the lust part of this Essay. 



KND OF PART THIRB. 






PART FOURTH. 



As one important purpose to be attained by the view which 1 
am about to take of the history of Yellow Fever, is that of 
establishing its identity, or near affinity and connexion, witk 
the fevers which are indisputably and notoriously produced 
by marsh miasmata ; — it seems expedient, first to ascertain 
the characteristic peculiarities of the latter, as they have been 
generally manifested in the temperate climates of Europe, in 
order that, being ascertained, they may afterwards serve as 
points or features of comparison and recognition, in regard to 
those which distinguish the Yellow Fever. 

These characteristic peculiarities of marsh fevers appear to 
be, 1st, that of occurring in their simple and mild form of 
intermittents during the spring ; 2d, that of being exasperat- 
ed, and converted to remitte nt, and, apparently, to continued 
fevers, by excessive summer heat, and this generally with a 
great increase of malignity, (especially in low and moist 
situations) when this excessive heat is long continued and ac- 
companied with a total or very unusual deprivation of rain ; 
3d, that of being reconverted and brought back to their mild 
intermitting form, at the approach or commencement of win- 
ter, and afterwards extinguished or suspended by a continued 
frost : 4th, that of most frequently and violently attacking 
strangers from colder climates, and more salubrious situa- 
tions ; — and 5th, that of never being communicated from per- 
son to person by a contagious property. Several facts and 
authorities, tending to prove these peculiarities of the * 
in question, have been incidentally mentioned in the pireed- 



207 

ing parts of this Essay. A multitude of others might be 
added, but the following will suffice. 

Dr. Lind, in his Essay on the Diseases of Europeans in 
Hot Climates, after mentioning, that " in particular spots of 
the low damp island of Portsea, agues frequently prevail, 
and sometimes the flux, during the autumnal season," adds 
" in some years they are much more frequent and violent 
than in others." It is observable, that their attack proves 
always most severe to strangers, or those who have formerly 
lived on a drier soil, and on a u more elevated situation." 
He next mentions, tiie regular tertians with perfect intermis- 
sions, which prevailed at Portsmouth in May, June, and 
July, 1765, and then proceeds in these words, "In the 
month pf August, the quicksilver, in Fahrenheit's thermome- 
ter, rose to 82" in the middle of the day. This heat, toge- 
ther with the want of refreshing rains, spread the fever, t/i- 
creased its violence, and, in many places, changed its form. 
At Portsmouth, and throughout almost the whole island of 
Portsea, an alarming continual, or remitting fever raged, which 
extended itself as far as Chichester. At the same time the 
town of Grosport, and the opposite side of the harbour, though 
distant only one mile from Portsmouth, enjoyed an almost total 
exemption from sickness of every kind; and in the neighbour- 
ing villages and farm houses on that side, only a mild regular 
tertian ague prevailed, which however distressed whole fami- 
lies. The violence of the fever, with its appearance in a 
continued remitting or intermitting form, marked, in some 
measure, the nature of the soil. In Portsmouth, its symptoms 
were bad, worse at Kingston, and still more dangerous and 
violent at a place called half-way houses, half a mile from 
Portsmouth, where scarcely one in a family escaped this 
fever, which there generally made its first attack with a deli- 
rium. In the large suburb of Portsmonth, called the com- 
mon, it seemed to rage with more violence than in the town, 
some few parts excepted : but even whole streets of this suburb, 



208 . 

together with the Iionses in the dock-yard, escaped it, P. 18, 
19, 20. 

This exemption of particular streets, kc, from the disease, 
is an important fact which often occurs in regard to marsh 
fevers, and will he easily understood from what has been men- 
tioned between pages 224 and 229 ; and it well deserves to be 
remembered, not only as a distinguishing mark of these 
fevers, (produced by a cause arising immediately from the 
soil) but also as an incontrovertible evidence of their total want 
of any contagious property ; for contagious fevers are not thus 
narrowly confined and limited in their progress. 

To this testimony of Dr. Lind, I will join that of the late 
Dr. Robert Hamilton, who practised as a physician, with 
great reputation, for more than forty years, at Lynn, in Nor- 
folk ,* and published " Observations on the Marsh Remittent 
Fever," which prevailed, with unusual violence and malig- 
nity, in that part of England, during several uncommonly hot 
summers, which followed a great inundation from the sea in 
1779, so as very nearly to resemble " its appearance in many 
places between the tropics." Of this fever, he says generally, 
" If a very wet winter and spring are succeeded by a very hot 
and dry summer, in which the ditches and marshes are nearly 
dried up, it is very generally epidemical, and spreads widely 
around us. It most commonly appears about the middle of 
August, and lasts till the ditches are filled with water, and 
the marshes somewhat covered ; which, with a frost, usually 
puts a period to its raging in tJiat form, for that season : for 
it now generally changes to the type of a genuine intermit- 
tent." He deemed this fever, as it prevailed after the inun- 
dation, in 1779, "to be the same distemper with the bilious 
remitting fever of the Netherlands, the tcrtiana duplex of 
Minorca, the remitting fever of Bengal, the yellow fever of 
the West Indies, and the bilious remittent of Senegal." Sup- 
posing it to "differ only in malignity and fatality from those 
of hot countries, in proportion to the difference of climate." 
See pages 27, 28, 32. 



209 

If we proceed to the continent of Europe, we shall find, 
that even in the northern, but low and damp island, upon 
which Copenhagen is situated, an excessively hot and dry 
summer, in 1652, was able to produce a violent epidemic ter- 
tian, of which Thomas Bartholine, (who was attacked, with 
all his family, by it) has given an account ;* and which fever 
was the more remarkable, because, upon dissecting the bo- 
dies of those who died of it, he found the stomach and duode- 
num always mortified, or, at least, inflamed, as is almost in- 
variably the case, in those who die of Yellow Fever. 

Passing over what Forestus and others have related of the 
violent marsh fevers, (once called the plague,) which fre- 
quently infested the city of Delft, (almost surrounded by stag- 
nant waters, and placed on low moist ground) we learn from 
Silvius de le Boe, that a very malignant remitting, and inter- 
mitting fever raged within his own observation, at Leyden, in 
1669, in consequence of a very hot summer and autumn, with 
little or no rain, and an unusual stagnation of the air ; by 
which the water of the canals and ditches became greatly di- 
minished, and highly corrupted. He mentions two-thirds of 
the principal inhabitants of that city as having died of this 
epidemic. See Prax. Med. tract. X. 

Sir John Pringle, treating of the autumnal fevers of the 
British army in Flanders, says, "this remitting fever attend- 
ed every campaign, and was most frequent and fatal after the 

* Thorax Bartholin! Historiarum anatomicarum rariorum Cent. I & II. Historia 
LVI. Febris tertiana Epidemia. 

" ./Estate 1652 prater mormm & coeli nostri consuetudinem calidissima & siccissima. 
Hafnice & vicinis locis grassabatur febris tertiana intermittents epidemia, qua? rau! las 
familias velut conspiratione quadam invasit, prostravitque. Varium in hac observavi- 
mus typum ; modo enim singulis recurrebat diebus, modd alternis, modo vaga, ssepis.- 
sirae post 4»v$«gfccu redibat. Symptomata varia comitabantur, ingens capitis dolor, 
imprimis colli seu musculorum occipitis, lumborum & dorsi, calor urens, vomitus bilio- 
sus, sitis, inquietudines, nonnunquam deliria, & petechia? remissionis tempore evanes- 
centes, & cum paroxysmo revertentes," &c. " Multis in hac urbe diuturnu vomi- 
itus post febi-em istam remansit, ut ventricuhim in febre hac imprims (iffectum, sicnr 
in malignis solet non dubitarira," &c 

27 



210 






Jwt summers of the years 1743 and 1747 ;* but, in the cam- 
paigns of 1744 and 1745, the seasons being temperate, fewer 
were seized, and the cases were milder." See Observations 
on Diseases of the Army, p. 172. The same respectable au- 
thor, treating, at p. 180, of the fevers among the troops sta- 
tioned near the inundations, in Dutch Brabant, in 1748, ob- 
serves that, " in the greatest heat of the weather, and rage of 
the distemper most of these fevers answered the description of 
the Ktivrof, or ardent fever of the ancients, which Hippocra- 
tes does not rank with the inflammatory diseases of the winter 
and spring, but with the epidemics of summer and autumn. 
(Aphor. lib. iii. Aphor. xxi.) Sir. J. Pringle adds, " but 
it was observable, that even in the worst parts of the country. 
as soon as the weather cooled, in the decline of autumn, the fe- 
vers began to assume a milder form ; and, in the end of the 
season, differed little from the common intermittents of other 
places." In the next page, he makes the following observa- 
tion : "At the height of the epidemic, it appeared that both 
intermittents and remittents, by extending or doubling their 
paroxysms, frequently changed into a continued and dangerous 
form, and that most of those whom we lost died in this way." 
Dr. Francis Home, who also served at the same time. 
with the British army in Flanders and Holland, gives a simi- 
lar account of these fevers. " The change of weather, - 
he) from heat to cold, made always a sensible alteration in 
the symptoms. In Jwt weather they were more severe, and the 
disease inclined more to the continued fever" Medical Facta 
and Experiments, p. 46.| 



• Werlhof de febribus, p. 3, mentions the excessive number of levers of various 
types, which infested almost all Europe, and especially marshy places, from the enor- 
mous heat of two summers ; " ab enornti Wo colore astivo annorum 17-26 k 
Van Swieten also makes a similar observation : f* Sic observatur post fervidnrimat 
sstates prsegressas autumnum hsemitrearum febrim /era cissimum esse," torn- ii- 
p. 455, and another, (torn. iii. p. 06) viz. : " Ubi post fervidissimas k siccissiraas 
sestates autumnali tempore grassantur epidemical febres continue, remittentes, &c.'* 
f Ml the epidemic marsh fevers described by Lancisi, appear to have begun about 
•he summer solstice, and to have increased and become more exasperated bj 



211 

The latter of these authors treating, at p. 18, of the 
"Epidemic Remittent Fever" of the Camp at Worms, in 
1743, says, " there is another symptom which attended this 
fever, and that is a jaundiced colour in their eyes and skin, 
and very often a complete jaundice." Sir John Pringlc also 
describing (at p. 72.) the marsh fevers of Flanders, says, 
" some grow yellow as in the jaundice : this colour was ob- 
served to be more frequent in the first campaign than after- 
wards : it was an unfavourable, but not a mortal sign." 
Afterwards Dr. Brocklesby mentioned, (at p. 269 of his Ob- 
servations) as occurring in the autumnal fever of 1758, among 
the soldiers, on the Isle of Wight, a "suffusion of bile, 
which had often tinged the skin of the deepest yellow, and 
sometimes blackish colour." We see, therefore, that even in 
temperate European climates, fevers from marsh miasmata 
sometimes have this symptom, in common with the bilious 
remittent, and Yellow Fevers between the tropics. 

These testimonies, concerning the intermittents of Europe, 
and the changes of which they are susceptible, might, proba- 
bly, be thought sufficient for the purpose intended to be an- 
swered by them ; I cannot, however, omit to notice their ap- 
pearance and effects, as they have occurred in Zealand, par- 
ticularly during the late expedition to that province. 

Dr. Wind, who translated into Dutch, Dr. Lind's Essay 
on Preserving the Health of Seamen, and who, with his fa- 
ther, had practised physic twenty-eight years in Walcheren, 
has added to that translation, as we are informed by Dr. 
Lind, the following account of these fevers, viz : " at Mid- 
dleburgh a sickness generally reigns towards the latter end of 
August, or the beginning of September, which is always most 
violent after hot summers. Its makes its appearance after the 
rains which generally fall in the latter end of July : the 



heat and dry weather until the autumnal equinox ; after which they were found to de- 
cline : and, finally, cease upon the accession of cold winds and rains at the beginning 
of winter ; and wherever fevers observe this course, they may safely be considered 
as resulting from marsh miasmata. 



212 

sooner it begins the longer it continues, being checked only by 
the coldness of the weather." 

'* Towards the end of August, and the beginning of Sep- 
tember, it is a continual burning fever, attended with a vomit- 
ing of bile, which is called the gall sickness." He afterwards 
mentions that "strangers, who have been accustomed to 
breathe a dry pure air do not recover so quickly" as the na- 
tives ; adding that this fever is " the same with the double 
tertian fevers between the tropics," that it is, " not infectious," 
and seldom proves '''mortal to the natives." — But that u the 
Scotch regiment, in the Dutch service has, at Sluys, been 
known to bury their whole number in three years." See 
Lind, on the diseases of Europeans in Hot Climates, p. 23, 
&c. This account of the morbid influence of marsh effluvia in 
Zealand, was but too well confirmed by the extensive sick- 
ness which so lately, and in a few weeks, disabled the British 
army there, at a time when no extraordinary heat or drought 
had occurred to aggravate the symptoms. In Dr. B lane's 
Letter to the Physician-General, dated Middleburgh, Octo- 
ber 3d, 1809, and printed, with other official documents, 
presented to both Houses of Parliament, in February, 1810, 
marked E. p. 103, is the following passage, viz : 

"It appears, from the last general weekly return, that near 
two-thirds of the whole numeral strength of the army is inca- 
pable of duty. The mortality, during the last four weeks, 
has been about one thousand. All the regiments are affected in 
nearly an equal degree ; and it does not appear that their ill- 
ness is connected with the nature of their duty, nor that it is 
owing to privation or neglect of any kind; for those are 
equally sickly who have enjoyed the utmost ease and comfort 
in cantonments, as those who have been engaged in the siege 
of Flushing." "Nor lias it been owing to any thing unfa- 
vourable in this year, in comparison" of former ones; on the 
contrary, the native inhabitants affirm that they are now less 
sickly than usual at the same season ; and they account for it 
from the unusual quantity of rain that has fallen the last two 



213 

or three months ; and they consider it as fully established by 
observation, that the most sickly seasons are those in which 
there are great drought and heat in the latter end of summer, 
and the early parts of autumn, owing, probably, to the in- 
creased putrefaction and exhalation produced by these causes. 
I find, upon inquiry, that a like degree of sickness prevailed 
among the French troops, who occupied Flushing during the 
last seven years ; and that, in former times, the Dutch troops 
from the Northern States of the United Provinces suffered 
equally. Other proofs, if necessary, could be adduced, to 
evince that the present unfortunate state of the army here, is 
solely imputable to the contamination of the air 9 from a soil 
the most productive of deleterious exhalations of any perhaps 
in Europe, producing an endemic fever, which has, at all times, 
been particularly severe upon strangers in the autumnal months. 
I find also, upon inquiry, that though this is by far the most 
sickly season, the residents of this, and the neighbouring 
islands, are far from enjoying at any season, the same de- 
gree of health as in the more salubrious parts of Europe ;" 
and, in an unpublished letter on this subject from Dr. Blane 
to the Surgeon General, dated at Middleburgh, October the 
4th, 1809, I find the following observation i " it is fortunate 
that the administration of medicine is simplified by the uni- 
formity of the cases, which almost all consist of the endemical 
intermitting and remitting fever.' 9 

This deplorable calamity has, however, enabled us to make 
some very useful additions to our stock of knowledge, respect- 
ing marsh fevers ; and one of these is a full and indisputable 
confirmation of the fact, which the most judicious and best in- 
formed physicians already believed, that these fevers do not 
possess any contagious power or quality whatever : of this I have 
numerous and decisive proofs now lying before me : a part of 
them will, however, be sufficient. 

But I ought previously to observe, that, as all the troops 
landed in Zealand were more or less exposed to the influence 
of marsh effluvia, it must have been difficult, if not impossible, 



214 

to distinguish the effects of contagion, had it existed among 
them, from those of miasmata ; and, therefore, I shall draw 
no conclusion on this subject from any thing which occurred 
to the twenty-six thousand eight hundred and forty-six pa- 
tients, including relapses, who were admitted into the gene- 
ral and regimental hospitals of the British army there, pre- 
vious to the 18th of November, 1809, or to those afterward* 
added to this number, before the final evacuation ; but I shall 
confine my inferences solely to what followed the return of se- 
veral regiments or battalions not required for the occupation 
of Walcheren, and the removal of twelve thousand eight hun- 
dred and sixty-three sick, (including a small number of 
wounded) from that island, and from South Beveland, be- 
tween the 21st of August and lCtli December, 1809, who were 
all landed, and placed in dry, wholesome situations, within 
the Kentish and Eastern districts, under the genera] superin- 
tendence of Mr. Keate, the Surgeon General. That gentle- 
man, at different times, visited, and minutely inspected, the 
several hospitals in these districts ; and, upon his return to 
London, on the 5th of October, 1809, immediately after be 
had performed this duty throughout the Eastern district, he 
obligingly put into my hands a statement of the results of his 
observations respecting the prevalent disease, from which I 
was permitted to make the following extract, viz. 

" It is certain, that more or less of the poison which created 
this sickness, has been imbibed by all the troops previously 
to their leaving Walcheren, and that, in many instances, it 
has not produced its noxious effects until the men have reached 
this country, and have even marched to their respective quar- 
ters. This is obvious at Colchester, Weeley, and Wood- 
bridge, where many have fallen down with this disorder, at 
the slight fatigue of a short march." 

" It does not appear that this disease is of a contagious na- 
ture, not one of the attendants, whether nurses, orderlies, oi 
medical officers, having contracted it, as I am informed.* 
Mr. Keate told me. relative to this point, that he had made 



215 

very minute inquiries on the subject, of every medical officer 
with whom he had an opportunity of conversing, and particu- 
Jarly of Drs. Fellowes, Roberts, Wardell, and Tice, and of 
staff-surgeons, Ross and Emery, and that they were all unani- 
mous in stating that no instance had fallen under their know- 
ledge of the disorder having been communicated to any per- 
son about the sick. 

Nor did subsequent information or observation alter the 
Surgeon General's opinion on this subject, as is fully proved 
by the following extract from his letter to Francis Moore, 
Esq. Deputy Secretary at War, dated 14th December, 1809. 

H I must also remark, after much inquiry from the most re- 
spectable medical officers into the subject, that neither in the 
Kent nor in the Eastern district, had any instance of conta- 
gion been known to have occurred in the General Hospital;" 
(i. e. those appropriated for the Walcheren sick) "a fact 
which sufficiently demonstrates the fallacy of the assertion ad- 
vanced against these establishments, and so readily credited 
by many persons, viz. that they are the chief cause and source 
of contagion in armies." 

The observations made by the Pliysician-General, when he 
visited the sick, returned from Walcheren, at Harwich, Col- 
chester, and Ipswich, in September, 1809, were similar to 
those of the Surgeon-General, in regard to the total absence 
of contagion, as appears by his three official letters to the 
Deputy Secretary at War, of the 11th, 13th, and 15th of that 
month, printed in the Minutes of Evidence on that subject, 
by order of the House of Commons ; and that his subsequent 
information, from the army physicians, and other medical 
officers, was of the same import, may be inferred from his 
printed testimony to the House of Commons, on the 8th of 
March, 1810, when, being asked this question, "might not a 
fever, of a more fatal kind than that which subsisted among 
the troops at Walcheren, be generated on board the trans- 
ports in which they came from that country, so that no infe- 
rence is to be drawn as to the state of the sick, at the time 



216 

they were put on board- he answered, - if that had ten 
the case, there would have been contagion in the chfferent ^hos- 
pitals I saw at Harwich, Colchester, and Ip^ch, and there 
was no contagion-^r 1ms there been any contagion 

To these testimonies I may doubtless be permitted to add 
the results of my own very minute and extensive inhumes on 
this, to me interesting subject, which have, without exception, 
most unequivocally manifested the total absence of contagion 
in or by any of the sick from Zealand. Such was the infor- 
mation given to me by Mr. Warren, Deputy Inspector of Hos- 
pitals, who, under the Surgeon General, had the supenntcn- 
danceof the sick from Zealand, in the Kentish district, as 
well as of Dr.Neale, then principal Medical Officer* the 
General Military Hospital, at Deal, and also of Doctor 
Faulkner, Faber, Turner, and Morgan, all Fellows of the 
College of Phvsicians, and physic ians to the army, or em- 
ployed as such temporarily, with the sick from Zealand, in 
that district; such also was my information from sir Jan 
Fellows and Dr. Roberts, army physicians, and irom Drs. 
Harvey and Laffan, who were then employed as such in the 
Eastern district. These gentlemen, as w ell as those in the 
Kentish district, uniformly assured me. that no patient, lin- 
ing the Walcheren or Zealand fever, had. as they believed, 
given that disease to any other; and that, according to then- 
knowledge and information, none of the attendants, or others 
employed in the several hospitals, and who had not been ex- 
posed to marsh miasmata in Zealand, were attacked with the 
fever in question. * 

* Mr Nixon, Surgeon to the first regiment of Foot Guards, favoured me V.th 
some valuable information respecting ihe extent and effects of the Zealand fever, upon 
the 3d battalion of that regiment, ,vhjch, to the number of 872, landed S 
land, the 2d of August; of these 359 were attacked with this fever, brtween the 
19th of that month and the Uth of September, (sixteen day, :) and though, on the 
last of these days, they embarked onboard the Leyden, to return to Urn country, 
and actually re-occupied the barracks at Chatham, on the 16th of September, only 
117 of the battalion bad uHimateh escaped the fever, on the 8th of March following; 
and some of the 117, who had so escaped, were, for the Jirst time, attacked by it. 



217 

In addition to those inquiries I made others, respecting the 
hospital ships and transports employed in removing the sick 
from Zealand to Harwich, Deal, and other ports in this king- 
dom, in order to ascertain whether any of their respective 
crews had hecn infected by this sen ice ; but I did not hear of 
a single instance in which this was even suspected to have 
happened. Deputy Inspector Warren, in a letter to me, da- 
ted the 9th of October, 1810, wrote as follows: " In reply to 
your question, relative to the state of health of the crews of 
the transports that were employed in com eying the sick from 
Walcheren to this country ? I have every reason to believe they 
remained free from the disease, with which the troops were 
affected ; as I do not find that more than two or three applica- 
tions were made for admitting sick seamen into the Hospital 
at Deal, and such applications would have been made to a 
considerable extent, if they had at all partaken of the disease." 

At my request, Dr. Faber made a similar application to 
Staff Surgeon Lidderdale, who had been employed at Flush" 
ing, in superintending the embarkation of the sick, removed 
thence to England ; and, in consequence thereof, Mr. Lid- 
derdale wrote to Dr. Faber, on the 22d of October, 1810, a 
letter, of which the following is an extract, viz. « The same 
transports were not always, but frequently, employed in re- 
moving the sick from Walcheren to this country ; and I did 
not observe that their crews laboured under the same disease 
as the sick ; and, from conversations with the navy, I learn- 
ed, that only those men who were on shore, and exposed to 
the same causes as the troops, laboured under the Walcheren 
fever." He afterwards mentions his having had opportunities 
of observing the Mia, (a large Hospital ship, carrying about 



as long afterwards as the middle of June^ 1810, Mr. Nixon, however, assured me, 
that neither in the Hospital at Chatham, nor in that of Westminster, to which this 
hattalian was afterwards removed, had there been any appearance of contagion. 
None of the Hospital servants who were not in Zealand having taken the fever, nor 
any of the soldiers' wives, or connexions. 

28 



218 

sixty patients in cradles) and declares, that he " saw nothing 
like infection extended to the crews of that ship." 

My inquiries were afterwards extended, in order to disco- 
ver whether any effect, indicating the existence of contagion, 
had been produced by the bedding and clothes used by the 
sick at Walcheren, and removed to this country mostly with- 
out being washed, and in a very filthy condition, as I was in- 
formed by Mr. Moss, Purveyor of Hospitals there, and by 
his Deputy, Mr. Boning, verbally. To the former of these 
gentlemen I addressed certain written questions, in the month 
of August, 1810; but he, being then on the eve of Ids depar- 
ture for Sicily, could not, as he stated in his letter to me of 
the 13th of that month, Si answer them otherwise than in a 
general way," viz. " several thousand articles of wet and 
dirty bedding, cloathing, kc. were received Erouj the regi- 
mental hospitals throughout the island, of which time did not 
permit either the drying or washing : I found it, therefore, 
necessary to require a board of survey, in order to decide 
upon the propriety of shipping them in their actual si 
the board having decided that, in so short a voyage, no dan- 
ger or damage could be expected,— the whole of the arti. lei 
in question were shipped by the dsia, Ceres, and Eleanor." 
He adds — 

" I have not heard that the least sickness w hatever prevail- 
ed among the crews of either of the above ships: and when 
it is considered that the stores were not landed for seveml 
ivceks beyond the calculation of the board of survey, it seem 
clear that the members were fully justified in their opinion." 

The bedding and clothing in question having been landi -d. 
after considerable delay, w as transferred to the store-keeper 
general, whose deputy, Mr. Barker, in answer to a note from 
the Surgeon-General, on this subject, wrote, (on the 25<fc of 
September, 1810) "that the dresses* and bedding, receive]] 

* These dresses were all offawtel, and mostly worn by the sick next to their 
shins,- they were, therefore, well suited to retain, as well as imbibe, contagion, 
had existed. Ami even if none had existed, it ought, according to the general opinion 



219 

from the several transports returned from Walcheren, were, 
in general* in a very foul state, and were immediately sent to 
the mills to be cleansed, but he did not hear of any infection 
having arisen from them to any of the parties through whose 
hands they passed. 

Considering these facts as more than sufficient to prove that 
the marsh fever of Zealand does not possess any contagious 
quality, I shall now proceed to a rapid view of the History of 
Fellow Fever in America and Spain. 

It has been asserted and believed, that the Yellow Fever, at 
least in its most violent form, did not attack the first settlers 
in America. Of the truth of this assertion it is now difficult 
to decide, because no one of the earlier historians has left us 
any account of their diseases sufficiently minute and discrimi- 
nating. It is, however, manifest from various facts related 
on good authority, and several passages in the writings of 
Peter Martyr, that the earlier Spanish adventurers to the 
West Indies suffered greatly by marsh miasmata, particularly 
those who first attempted to establish themselves in Darien 
about the year 1512, at a place which the Spaniards called 
Sancta Maria Antiqua, where many of them died. Of this 
place Peter Martyr writes, in the 6th chapter of his third 
Decade, "that the air is more pestilential than in Sardus 
(Sardinia). The Spanish inhabitants are all pale and yellow, 
like unto them which have the yellow jaundice," And this 
he ascribes not to the latitude but to the local circumstances 
of the place, situated " on the banks of the river of Dariena, 
in a deep valley, and environed on every side with high hills ; 
by reason whereof it receiveth the sun-beams at noon-tide, 

on this subject, to have been generated by these dresses, and by the bedding of the 
sick, (which, as I was informed by Mr. Moss, amounted to more than 10,000 separate 
articles) considering the foul condition in which they were brought and kept together 
for, I believe, six or eight weeks; and, as no such effect happened, we may here 
find another proof that contagion, properly so called, is not generated by accumula- 
tions of mere animal filth, even when derived from living human bodies, under disease, 
and especially that of marsh fever?. 



220 

directly perpendicular over their heads ; and they are, th< 
fore, sore vexed by the reflection of the beams," 6cc. " The 
place is also outrageous by the nature of the soil, by reason it 
is compassed about with muddy and stinking marshes, the 
infection whereof is not a little increased by the heat/* &c. 
He adds, " now, therefore, they consult of removing their 
habitations : necessity caused them first to fasten their foot 
here, because they, which first arrived in those lands, were 
oppressed with such urgent hunger, that they had no respect 
to change the place, although they were thus vexed by the 
contagion of the soil, and heat of the sun ; beside the corrupt 
water and infectious air, by reason of venomous vapours and 
exhalations arising from the same." See Robert Eden's 
Translation, in black letter, which I have here used, (but with 
modern spelling) not having the Latin original at hand. 
This extract will sufficiently prove what, indeed, could not 
reasonably be doubted, that mai-sh effluvia have, at all times, 
destroyed human life in America, as well as in other par 
the world : and if they did not produce an epidemic yellow 
fever, in the highest degree, among the first European adven- 
turers thither, the reason, probably, was, that before consider- 
able towns were built, the solar heat would not have arisen so 
high, as it now docs in the cities where that disease has most 
often prevailed, nor would the soil, whilst nearly covered by 
trees, be accessible to the sun's rays, or capable of producing 
miasmata so highly concocted, (if I may use that expression) 
and virulent, as when deprived of its natural verdure and pro- 
tecting shade, nor would they so readily find the means of in- 
temperance and debauchery which large cities afford. 

The earliest marsh, and probably Yellow Fever, of which 
we have any distinct account, as prevailing epidemically, and 
With great mortality, in the AVest Indies, was. I believe, that 
which occurred at Barbadoes, in the year 1647. From two 
letters, written by Mr. Richard Vines, then a planter and 
practitioner of physic in that island, (which were published 
by the late Governor Hutchinson, in his collection of Mas 



221 

ehusett's Papers) and from Mr. Ligon's History of Barba- 
does, it appears, that this fever began in or about the month 
of August, after a severe drought of six months continuance,* 
attended with very hot weather, and followed by a great 
scarcity of food. Mr. Vines' letters were addressed to Go- 
vernor Winthorp, in New England, whence he had lately 
arrived ; a circumstance which will account for his sentiments 
and language on this subject. He appears to have considered 
the fe^cr as a punishment for the sins of the people of the 
island, proceeding from " the Lord's heavy Iiand in wrath ,•" 
and, being satisfied with this cause, he does not seem to have 
inquired for, or thought of any other, but says, in his second 
letter, dated April 29th, 1648, that, " the sickness was an ab- 
solute plague, very infectiousf and destroying, insomuch that 
in our parish, there were buried twenty in a week, and many 
weeks together fifteen or sixteen. It first seized on the ablest 
men both for account and ability of body. Many who had 
begun and almost finished great sugar works, who dandled 
themselves in their hopes, were suddenly laid in the dust, and 
their 'estates left unto strangers. Our New England men 
here had their share, and so had all nations, especially Dutch- 

* But little more than twenty years had then elapsed since the first settlement 
was made in that island ; and so little of it was at that time cleared and cultivated, 
that dry weather, assisted by great heat, was best suited to the production of noxious 
miasmata ; contrary to what has been the case at Barbadoes, since it attained its high- 
est state of cultivation many years ago. About the time when this fever prevailed, 
there had been a great and sudden influx of inhabitants from England, in consequence 
of the civil commotions at home, and of other causes. Indeed, there never has been 
an extensively epidemic Yellow Fever known in the West Indies without the previous 
arrival of considerable numbers of persons from more temperate climates. Hence 
times of sickness have there commonly been times of war. During peace, a few pas- 
sengers, arriving in single ships, and dispersing themselves in the cooler, and more 
wholesome parts of the country, are mostly enabled to escape the Yellow Fever; and 
the seasoned inhabitants are rarely susceptible of it. 

•j- Believing the disease to be "an absolute plague" Mr. Vines, must naturally 
conclude that it was " very infectious," especially as many persons were attacked by 
it nearly at the same time ; a circumstance which, in that age, was thought sufficient 
evidence of the contagious nature of a disease . 



222 



men, of whom died a great company, even the wisest of 
them." 

Mr. Richard Ligon, whose History of Barbadoes was pub- 
lished in 1657, tells us that he arrived there early in Septem- 
ber, 1647, when "the inhabitants of the islands, and shipping 
too, were so grievously visited with the plague, (or as killing 
a disease) that before a month was expired after our arrival, 
the living were hardly- able to bury the dead." Though not 
a medical man like Mr. Vines, he appears to have bestowed 
some thought on the physical causes of this disease, and upon 
the question, " whether it were brought thither in shipping :" 
or occasioned "by the distempers (irregularities) of the peo- 
ple of the island, who, by the ill diet they keep, and drinking 
strong waters, bring diseases upon themselves." And though 
lie observes that the truth on this subject " was not certainly 
known," he adds, that lie has •• reason to believe the latter; 
because, for one woman that died there were ten men : and 
the men were the greater dcbnystt- most debauched'. 

" In this sad time (says he) we arrive 1 , in this island ; and it 
was a doubt whether this disease or famine threatened most, 
there being a general scarcity of victuals throughout the 
whole island." P. 21. 

The reason which induced Mr. Ligon to think that the 
disease had not been imported, is certainly deserving of at- 
tention : for to have been imported it must have been conta- 
gious, and a contagious disease would not have spared the 
women in a manner so extraordinary, merely because (hey 
lived more temperately. There were, howe\ er. much better 
reasons for not considering it as an imported disease, which 
Ligon mentions at p. 25, without being sufficiently sensible of 
their operation at that time : I mean those arising from the 
situation and local circumstances of Bridgetown and its har- 
bour, where the disease seems to have mostly prevailed. 
" Upon the most inward part of the Bay (says Ligon) stand-, 
the town, which is about the bigness of Hounslow, and is 
called the Bridge, for that a long bridge was made at fir*t 



i 



223 

over a little nook of the sea, which was rather a bog than a 
sea. A town ill situate ; for, if they had considered health as 
they did conveniency, they never would have set it there" 
kc. &c. " But (adds lie) the main oversight was to huild 
their town upon so unwholesome a place. For. the ground 
being somewhat lower than the sea banks are, the spring tides 
flow over, and there remain ; making a great part of that flat, 
a kind of bog or morass, which vents out so loathsome a sa- 
vour, as cannot but breed ill blood, and is, no doubt, the 
occasion of much sickness, to those that live there." And 
when it is recollected that this morass was at the east side of 
the town, and that the trade wind blowing over the morass 
upon the town, would directly convey its exhalations to the 
inhabitants, and that the long-continued hot and dry weather 
would necessarily render these exhalations uncommonly noxi- 
ous, we surely need not look for any other morbific agent or 
influence. 

A similar fever, and doubtless from similar causes, pre- 
vailed about the same time at St. Christophers, Guadalupe, 
&c. Mr. Webster has lately published the following extract 
respecting it, from a MS. of the New England Historian, 
Mr. Hubbard, viz. : " It extended through the plantations in 
America,* and in the West Indies. There died at Barbadoes 
and St. Kitts five or six thousand each ; whether it was a 
plague, or pestilential fever, it prevailed in the islands, ac- 
companied with great drought, which cut short potatoes, 
(doubtless the sweet potatoe, or convolvulus battatas) and 
fruit." See New- York Medical Repository, vol. vii. p. 322. 
P. Du Tertre also mentions this disease, and calls it the 

♦Governor Wbthrop, in a letter to Mr. Vines, dated at Boston, 24th August, 1647, 
had mentioned an epidemic sickness which then lately overran that part of America, 
and which appears to have been an influenza, and not a marsh, or Yellow Fever. Mr. 
Vines, after acknowledging the receipt of this letter, writes, (with sentiments like 
those he had entertained of the epidemic at Barbadoes) " I perceive by your letter, 
that the Lord did shake his rod over New England: it was his great mercy, only to 
put you in remembrance." By these expressions we may conclude, that the disease of 
^'ew England was attended with little or no mortalitv. 



22i 

plague, (la peste, jusqu' alors inconnue dans les isles, &c.) 
He says it began at St. Christopher, and in eighteen months 
carried off one-third of the inhabitants. That it was accom- 
panied with a violent pain of the head, great debility of the 
limbs, and a constant vomiting; and that in three days it 
sent the patient to his grave. Perhaps this is nearly as good 
a description of the Yellow Fever as one, who was not a 
medical man, might then be expected to give of it. He adds, 
that this disease was brought to Guadalupe by a ship called 
" Le Bceuf," from La Rochelle, in France. He had prei iously 
stated that it was imported by some ships (" quelqucs navii 
into the French islands, (St. Christopher's bring then half 
French) without any mention of their names op the pi 
whence they came, and, probably, he had no better n 
for this loose statement that a belief that the plague, till then, 
as lie says, unknown in that part of the world, must have been 
imported, and, of course, imported by ships, when the places 
to which it was supposed to have been introduced were islands. 
He did not know that the plague (even if it had then been at 
La Rochelle) could not exist, much less spread epidemically, 
within the tropics ; I need not observe that this is also true 
of typhus fever : because the latter has not the smallest re- 
semblance to a disease, attended with constant vomiting, and 
which generally proved fatal in three days. Therefore, Du 
Tcrre's supposition, that the disease was imported and con- 
tagious, deserves no attention. 

Fortunately, those peculiarities of season, and of local cir- 
cumstances, which are necessary to render marsh fevers both 
epidemical and violent, do not commonly recur but at con- 
siderable intervals : and I do not find that the Yellow Fever 
again became prevalent in the West Indies until about the 
year 1686, when it appeared at Martinico. and subsisted for 
several years. And, as a French ship of war, the Oriflamme, 
arrived about the same time at that island, with a number of 
French people, who had, some time before, settled themselves 
at Merguy and Bancok, in Siam, (whence they had been 



225 

driven, when the French intrigues at that court were frusr 
trated) the disease, as usual, was supposed to have been im- 
ported by that ship, and, therefore, was called Mai tie Siam, 
There is not, however, so far as I can discover, any account 
of the supposed introduction of this disease by the Oriflamme, 
except that which is given by Father Lab at, a Dominican or 
Jacobin Friar, who arrived at Martinico the 29th January, 
1694, seven or eight years after the event in question ; and 
his account (which must have depended on hearsay) is ex- 
tremely loose and defective.* He tells us that the Oriflamme 



• Father Labat, after mentioning that one of his order, le Pere Loyer, had been 
lately attacked with a disease of which, in the course of it, he was supposed to be dead 
.five or six times, but which without proving mortal, lasted thirty-two days, adds, 
M On appelloit cette maladie le Mai de Siam, parcequ'il avoit ete apporte a la Martin- 
ique par le Vaisseau du Roi, V Oriflamme, qui, revenant de Siam, avec les debris dos 
Elablissemens qu'on avoit fait a Merguy &c a Bancok, avoit touche au Bresil, ou 
il avoit gagne cette maladie, qui y faisoit de grands ravages depuis Sept ou hvit ans* 
Ce vaisseau perit en retournant en France. Les Symptomes de cette maladie etoient 
autant differens, que I 'etoient les temperamens de ceux qui en etoient attaquez, ou 
les causes qui la pouvoient produire. Ordinairement elle commeucoit par un grand 
mal de teste Sc de reins, qui etoit suivie tantot d'uue grosse fievre, et tan tot d'une 
fievre interne, qui ne se manifestoit point au dehors." 

" Souvent il survenoit un debovdement de Sang; par tons les conduits du corps, 
memepar les pores ; quelques fois on rendoit des paquets deversde diflerentes grandeurs 
& couleurs, par haut & par bas. II paroissoit a quelques uns des bubons sous les aislelles 
& aux aisnes, les uns pleins de Sang caille noir & puant, & les autres pleins de vers. 
Ce que cette maladie avoit de commode, e'est qu' elle emportoit les gens en fort 
peu de temps; six ou sept jours tout au plus terminoient l' affaire." He adds, that 
he had known but two persons who died of the disease, after it had continued 
more than fifteen days; that some persons, who felt nothing more than a little head- 
ache, fell down dead in the street, while walking for the air; and that in most of 
them, the flesh became as black and putrid in a quarter of an hour after death, 
as if they had been dead four or five days :-— That the English, who were frequently 
made prisoners, earned the disease to their islands ; and that it was communicated 
by the same means to the Spaniards and Dutch, and made great ravages when he 
left the islands, in .1705. He concludes by saying, that he was attacked twice with 
this disease ; that he escaped the first time, after four days of fever, and vonuting of 
blood,- (" apres quatre jours de fievre & de vomissement de sang") but, that the se- 
cond time he was, imdanger six or seven days. Such is his account, faithfully and fid- 
ly extracted, from pages 72, 73, and 74, of the 1st vol. of the original Paris edi- 
tion of his " Nouveau Voyage Aux Isles de r.\meriques," in 6 vols. 12mo. printed in 
1722. Dr. Clirisholm, at p. 105 and f06, of the 2d vol. of his essay, has given 

29 



226 

touched at Brasil, and caught the disease, which he represents 
as having been prevalent there for seven or eight years. 
There is, however, no reason, that I can discover, to believe 
that any coiUagimis fever has, at any time, subsisted in Brasil, 
though that country is not exempt from violent marsh fevers ; 
nor is it probable, considering the known jealousy of the Por- 
tuguese government, in regard to the admission of strangers 
at Brasil, that any would have been permitted to land ii-om 
the Oriflamme, and communicate with the inhabitants, so as 
to become infected by a fever of that sort, if it had cm 
there. We are not even told which of the harbours in that 
extensive country the Oriflamme entered ; she might have 
anchored in one which was surrounded \n ith marshes, and I 
should conclude this to have been the case, if it were a- 



an extract on this subject, taken avowedly from the Histoire Generale Des Voyages, 
which extract is very incorrect and defective, though he asserts that his i 
will find it " is literally taken from the original " An assertion which ought not to 
have been made, because it is not true, and because he manifestly had had no op- 
portunity of comparing this extract'with the anginal of Pere Labat. Unfortunately, 
there are but too mauy other instances of his want of caution in making assertions, 
even the most positive ; though 1 am willing to believe, ih;»t an intention to mislead 
has not been among his motives. Such also is the account of a disease which, accord- 
ing to Dr. (Jhisliolm, "differs m ate rially from the endemic yellow remittent, and 
bears a striking affinity to the true pi gue, as well as to the malignant pestilential 
Fever of 1793;" and we, therefore, need not wonder that tins gentleman, who is 
anxious to assimilate Yellow Fewrwith plague, should state this account I 
been given by La Fabat, with his accustomed accuracy and minuteness,*' though I 
believe few other persons will be saiisfied with it in these respects. To say no tiling 
of its important omissions, who will believe the occurrence of buboes, sometimes 
foiled with stinking, black, coagulated blood, and at other limes ~JHth worm* ? 
or that there was any foundation for what he says of packets or bundles of worms, 
of difteient sizes and colours, discharged upwarus and downwards.'' excepting this, 
that persons troubled wiU» worms, often discharge them in consequence oi 
and some other diseases ; though their doing so is not a symptom peculiar to any dis- 
ease, and much less tothe.l/a/ de Siam lui in truth, Pere Labat dots not seem 
to have intended iully to deacriha the symptoms of that disease, which he says 
were as different as the temperatnents of the individuals attacked by it, and at the 
causes by which it wu« produced; a plain indication that he considered the d ia ease 
as arising from different causes, and, consequently, not always from contagion. 
This part, now ever, of Labat s account, is one of those which are omitted in Dr 
Chisholm's extract. 



221 

gained, that a fever was prevalent among her passengers and 
crew before they reached Martinico, and not until their 
arrival in Brasil ; but if, as seems not improbable, this only 
happened upon their arrival at Martinico, we can have no 
difficulty in finding abundant, and much more likely causes 
for the disease in the carenage of that island, which even 
Dr. Chisholin declares to be " the most sickly Jwle in the 
West Indies ;" (vol. 2. p. 84.) or, indeed, at St. Pierre, the only 
other harbour of that island in which a ship of war, circum- 
stanced as the Oriflamme was, can be supposed to have re- 
mained.* And, indeed, the greater part of Martinico, is so 
abundant in every thing favourable to the production of the 
most deleterious miasmata, that there is no island in the West 
Indies of the same size in which all the varieties of marsh 
fevers prevail oftener, or with greater mortality ; nor can 
any thing be more chimerical or uni-easonable tfcan the having 
recourse cither to Brasil or Siam,] for contagion, as the cause 
of any fever which ever was prevalent in the West Indies. 
Of this a multitude of proofs might be given, if the notoriety 
of the facts did not render them completely unnecessary. 

* Dr. Chisholm, having mentioned that " the prevalence of the yellow remittent fe- 
ver, at a certain period of the year, at Fort Royal, (Martinico) should not excite 
surprise, the cause being so abundant in its neighbourhood," adds, " that part of the 
city of St. Pierre, called the mouillage, being very loiv and moist, although not marshy, 
is also subject to the destructive fever during the same period, the hotter months." 

f Kaempfer, who touched at Siam, in his way to Japan, gives the following account 
of the river Merinan, the part most connected with the subject of marsh fever. " It 
overflows its branches like the Nile in Egypt, though, at contrary times, and by setting 
the country under water, renders it fruitful. This overflowing begins with 1 the month 
of September." "In December, the waters begin to fall by degrees." " When the 
waters fall, and return to their former channel, (the river) they (the inhabitants) are 
apprehensive that. a great mortality -will ensue, among men and cattle : to avert which 
calamity, a solemn festival is kept throughout the whole country, in order to appease 
the destroying spirits, (miasmata) which remain after the water is run off" "The 
banks of this river are low, and, for the greater part, marshy, vet" — " they are pretty 
well inhabited : along them appear many villages, the houses of which are raised on 
piles." " From Bankok to the harbour, there is nothing but forests, deserts, and tooras- 
ses." Ksempfer's History of Japan, vol. 1. p. 44. In such a country and cl : mate, 
marsh fevers may well be supposed to prevail, whenever the surface of the inun- 
dated ground is left bare, and exposed to the sun's rays. 



228 

Soon after this epidemic prevalence of Yellow Fever at 
Martinico, it seems to have occasioned great mortality at 
JVH'is, (i. e. in 1689,; but no description of it, worthy of 
notice, has been preserved. 

The same fe\er appeared again as an epidemic at Barba- 
does, in 1695, and continued for several years after. Mr. 
Hughes mentions this on the authority of Dr. Gamble, who is 
stated by him to remember that this fever " was very fatal" in 
that year ; and, as all who had any accurate knowledge of it 
in 1647, were probably dead or removed, " it was then called 
the new distemper," and afterwards " KendaVs fever ;" also 
" the pestilential fever, and bilious fever." It is said to have 
been frequent and fatal in May,* June, July, and August, 
and then mostly " among strangers ;" " though a great many 
of the inhabitants, in the year 1696, died of it; and a great 
many at different periods since." " The same symptoms did 
not always appear in all patients ; nor alike in every year." 
See Natural History of Barbadoes, p. 37. 

This statement is amply confirmed by Captain Thoma? 
Phillips, in the account of his Voyage to Africa and Barba- 
does, published in the 6th volume of Churchill's Collection. 
He was at Barbadoes with a large ship in 1694, and sav>, h 
wns the fate of that island to be then " violently infected witli 



* Barbadoes -was then so generally and highly cultivated, and the soil so much 
more apt to become deficient, rather than redundant in moisture, that the nuns, 
which commonly begin there in the month of May, were then, as at present, bet- 
ter suited to the production of Miasmata, than the very dry weather which produ- 
ced them in 1647. Some other West Indian islands have undei-gone a similar change, 
particularly Antigua. Dr. Chisholm states, that when the French, under Mons. 
D'Enambuc, were driven from St. Christophers by the Spaniards, in 1629, and 
" sought an asylum in Antigua, they found it so unhealthy, so marshy, aud so inca- 
pable of cultivation, that they, with one accord, iutreated their leader to conduct 
them to Montserrat," them " inhabited by the Caraibes." Since that time, however, 
both the soil and atmosphere have frequently become so dry as to produce effects 
highly detrimental to the inhabitants and their cattle, &c. Some of these Dr. 
Chisholm mentions as having occurred in 1779, adding, " when these destructive dr* 
tracts of weather are suddenly succeeded by a profusion of rain, which generally 
happens once in three or five years, a very fatal epidemic remittent is the conse- 
quence." See his Essay, &c. vol. 3d, p. 976 tad 879. 



229 

the plague, so that, in the late war, it proved a perfect gravt 
to most that came there, all new comers being generally seized 
with pestilence ; of which very few recovered. Captain Tho- 
mas Sherman, of his Majesty's ship Tiger, in two years 
that he lay there, buried out of her, 600 men, as he told me, 
though his compliment was but 200 ; but still pressing new 
out of the merchant ships that came in to recruit his number 
in the room of those that died daily." u I lost (adds Captain 
Phillips) about eighteen of my men by it, and, in truth, I did 
not expect to escape myself, and was, therefore, so indiffe- 
rent that there was not a friend, or acquaintance of mine, 
seized with the distemper, but I freely and frequently went to 
visit him, which possibly was the reason that I escaped, by 
having accustomed myself to the town, and most infectious air 
from the beginning, which I did by the advice of the ever- 
honoured and worthy Colonel Kendal, &c." * while those 
that kept in the country, in better air for fear of it, were 
commonly infected when they came on any business to town. 
Here died about twenty masters of ships during my stay here, 
of which number were Captains Gurney and Bowles, who 
commanded his Majesty's ships, Bristol and Play-Prize." 
P. 253. 

It appears from this account that the disease prevailed chief- 
ly in Bridgetown, and that persons coming to it from healthier 
parts of the country, and imbibing miasmata, produced by the 
local circumstances which Ligon had long before described, 
were attacked by the fever, as constantly happens on similar 
occasions, at Charleston, Philadelphia, &c 

Here it may be observed that, in every instance, wherein 
the causes of marsh fever have been so powerful as to produce 
a violent epidemic in the West Indies, and with that exaspera- 
tion of symptoms which seems more incidental and natural to 
this kind of fever, than to any other disease, persons have 
been disposed to consider it as the plague, or a new distem- 
per. Dr. Henry Warren fell into the same mistake after- 
wards, (as Dr. Chisholm appears to have done, more recent* 



230 

ly, at Grenada,) when the Yellow Fever again became preva- 
lent at Barbadoes, between the year 1752 and 1738. The 
true plague, indeed, had not appeared in any part of Europe 
holding a communication with the West Indies, subsequently 
to the years 1720 and 1721, when it proved most fatal at Mar- 
seilles and in some other parts of Provence ; and. therefore, 
Dr. Warren concluded, that the Yellow Fever, which lit 
at Barbadoes, in 1732, and the following years, and which he 
denominated a " malignant fever," was a continuation of the 
'plague, which he imagined to have been brought from Mar- 
seilles to Martinico, and thence to Barbadoes, in 1721. by the 
Lynn ship of war ; although Dr. Towno. who lived and 
practised as a physician at Barbadoes, about that time, and, 
in 1724, wrote upon the Yellow Fever (here, under the deno- 
mination of " Febris ardens biliosa,'* appeals to have bad no 
knowledge or suspicion of any such importation, or of any dif- 
ference between the Yellow Fever of his time, and that which 
had previously occurred ; nor of its being any other than an 
indigenous production of that island ;* yet Dr. Warren 
charges Towne with having confounded u two most different 
maladies," viz. " the malignant and the ardent fever of Barba- 
does;" and he represents the former as being a fever M truly 
of the pestilential kind," upon grounds and reasons which Dr. 
Hillary, and others, afterwards contested as being chimeri- 

* Towne describes his ardent bilious fever as Commonly terminating; " in a favoura- 
ble crisis, or the death of the patient, about the fourth day after the attack." (Trea- 
tise on the Diseases of the West Indies, &c. p. 20.) He supposes this fever to pro- 
ceed from a redundance of bile, and that the yellow suffusion was produced by the 
efforts of nature, to depurate the blood, by throwing tbis redundant bile upon the 
surface. " The regular crisis, therefore, of this fever, (says he) generally disco- 
vers itself by a suffusion of the bile all over the surface of the body about the third 
day.*' He adds, that an appearance of it may often be discovered "in twelve I ours 
after the attack, if vou carefiilly inspect the couts of the eves, and the sooner it ap- 
pears the more encouraging is the prognostic," &c. 

I have mentioned, at p. 34, my belief, that the t.ellovness might, with attention, 
be, in many instances, " first discovered on the eijes" Probably this would a 
be the case, if their p re domina ting redress, in the early part of this fever, did not 
render the yellow tinge, in a great degree, imperceptible. 



231 

cal or fallacious. But, independently of their facts and argu- 
ments on this subject, what I have mentioned, at p. 222, 
224. of the acknowledged and absolute impossibility of pro- 
pagating the plague within the tropics, will sufficiently refute 
Dr. Warren's opinions and allegations. 

Dr. Hillary was a well-educated physician, and practised, 
with unequalled credit, for many years, in Barbadoes ; and, 
as the Yellow Fever does not appear to have prevailed there 
epidemically, during his time, he must have had the best op- 
portunities for ascertaining whether it possessed any conta- 
gious property or not ; especially as he, undoubtedly, saw 
cases of it, arising from all the several causes which have been 
already mentioned as capable of producing idiopathic Yellow 
Fever ; some of which might be supposed, more likely than 
marsh miasmata, to occasion fever with a contagious quality. 
And lie has delivered the result of all his observations in the 
following passage, viz. : 

u I never could observe any one instance, where I could say, 
that one person was infected by, or received this fever from, 
another person who had it ; neither have I ever seen two people 
sick in this fever in the same house, at, or near, the same 
time, unless they were brought into the same house when they 
had the fever upon them, before they came in. From whence 
(adds he) we may conclude, that it has nothing of a conta- 
gious or pestilential nature in it, and that it is a different fever 
in all respects, as it will more fully appear hereafter." See 
his volume on air, and Epidemical Diseases, in Barbadoes, 
2d edit. p. 145, 6. 

In confirmation of Dr. Hillary's testimony, I shall adduce 
that of Dr. James Clark, now, or late, of Dominica, deliver- 
ed in his Treatise on the Yellow Fever, &c. after twenty -five 
years constant and extensive practice in the West Indies. At 
p. 22, he states facts respecting the appearance of this fever 
in Dominica, during the years 1793, 4, 5, and 6, in which 
years Dr. Chisholm asserts the fever at that island to have 
been, what he calls, the malignant pestilential fever, brought 



232 



to Grenada by the Hankey, in 1793, and thence propagated 
to the other islands : these facts decidedly prove that this 
supposed malignant fever manifested no contagious quality in 
Dominica ; but I shall reserve them to he employed in my 
appendix, No. 7, on that subject. The following paragraph, 
taken from p. 52, 3, of Dr. Clark's Treatise, appears to re- 
late more immediately to the Yellow Fever, as it commonly 
occurred before the year 1793. 

This fever has not prevailed much in these Windward Ca- 
ribbee islands for many years past. At Fort Royal, in Mar- 
tinique, where there is a great prevalence of mephitic efflu- 
via, arising from the marshy ground at the back of the town, 
it generally broke out in the summer or autumnal season, on 
the arrival of troops from France, or of a number of seamen 
who had never been in the West Indies before : and the same 
thing happened at Point a Petre, in Grand Terre, Guadaloupe, 
almost annually, and from the same cause ; but it was never 
looked upon as an infectious disease, nor did it ever spread 
among the natives of the towns, or among those who were 
seasoned to the climates; nor was it ever carried from thence to 
the other islands. In this island but few cases have occurred 
for these last twenty years, and these have chiefly been at 
Prince Rupert's Head, where from the stagnated water in a 
large morass near the town and fort, the marsh miasmata pre- 
vails in a higher degree. Since the sicampy places, which 
were in the town of Boseau, have been filled up. this fever 
has been seldom observed ; but, previous to the year l 
we had generally violent thunder storms, heavy rains, or se- 
vere gales of wind, during the autumnal season :" and these 
Dr. Clark considers as obviating the prevalence of this 
fever. 

I have the more readily availed myself of Dr. Clark'* 
timony, concerning the Yellow Fever at Martinico and Gua- 
daloupe, because, for more than twenty years, he resided in 
an island between and very near to both, and because I believe 



233 

that no French physician, practising in either of those islands, 
has written any thing on the subject worthy of notice. 

In regard to Grenada, I have Dr. Chisholm's authority 
for asserting, that, from the year 1763, when that island 
'•was ceded to Great Britain, and till the year 1793, ( thirty 
tjearsj no contagions fever, and no epidemic, of the charac- 
ter of the malignant pestilential fever, appeared" there. See 
Essay, &c. vol. 1, p. 295. Whether the fever of 1793 was 
such as Dr. Chisholin has described it, will, I hope, be fully 
ascertained in my seventh appendix. 

And here 1 shall close my view of this subject, so far as 
relates to the Windward Caribbee islands, with an addition 
of only one document, declaratory of the opinions and expe- 
rience, in those islands, and on this question, of the officers 
of the hospital -staff, in the army, commanded by Sir Ralph 
Abercrombic, during the year 1796, and a great part of 1797, 
when, unfortunately, they had but too many opportunities of 
seeing and treating the Yellow Fever. That my readers may 
be informed of the origin of this document^ I must observe, 
that, in November, 1796, the medical staff-officers at Marti- 
nico, were assembled at the General Hospital of La Charite, 
when an order from the army medical board was read to them, 
requiring their opinions, concerning the disorders most pre- 
valent in that army : and it being proposed that a committee 
should be appointed, to prepare a statement of our opinions, I 
suggested that a single general statement would, as I con- 
ceived, but imperfectly answer the purpose, and that it might 
be better that each individual should separately state his own 
opinions ; and this suggestion being adopted, Mr. Young, 
Inspector- General of the Hospitals to that army, after some 
delay, was furnished with our separate opinions, and with 
those of the Hospital-staff officers in the other islands ; and, 
in consequence thereof, he wrote a letter to the army me- 
dical board, dated St. Pierre, 23d July, 1797, of which the 
following is an extract, viz. : 

By his Majesty's ship, Arethusa, I send, agreeable to my 
fetter of the 25th ult under cover to the Secretary to the 

30 



2te 



board, the opinions of the medical officers of this staff, on the 
prevailing diseases among the troops in this country, by 
which the board will perceive that contagion, or infection 
has had little or no share in the mortality ; and I must beg 
leave to add, that it has never occurred in a single instance, to 
my observation." My own individual opinion was in exact 
conformity with that which Mr. Young has here expre- 
I had never discovered any appearance of contagion at St. 
Lucia, nor when placed at the head of the hospital depart- 
ment, at Barbadoes, in the summer of 1796, — nor after- 
wards, when officiating as physician to the forces at Martini- 
co ; nor again when placed at the head of the medical staff in 
Grenada, during a great part of 1797, and until my return 
to England. 

St. Domingo next presents itself to our observation, in re- 
gard to the history of Yellow Fever : of its aptitude in manv 
parts, to produce highly noxious miasmata, and the fe 
resulting therefrom, in all their various forms, there has 
been but too much evidence even within a few years. Wit- 
ness the many thousands of British soldiers, who peri- 
there by these fevers, between the years 1793 and 1799, and 
the numerous French army, sent thither in 1805, under Ge- 
neral Leclerc, and which in a short space was nearly annihi- 
lated by the same fevers ; of which a very sufficient account 
has been given in the Medical History (Histoire Medicale' 
of that army by its chief physician, M. Gilbert. 

The earliest mention which I recollect of the prevalence ol 
Yellow Fever in St. Domingo, is contained in certain manu- 
scripts, of M. Bourgeois, formerly Secretary to the Chambre 
of Agriculture, at Cape Francais, published, after his death, 
by his nephew, in 2 vols. 8vo. under the title of •• Voyages 
Interessans Dans Differentes Colonies ;" from these it ap- 
years, (p. 202.) that, in the year 1731, a Spanish squadron 
arrived at Cape Francais, commanded by Don Manuel Lopflu 
Pintado, in the St. Louis, of eighty guns, who, besides several 
other ships of war, had, under his convoy, some >ery rich 



235 

galleons. They were returning to Spain from Porto Bello, 
and, having suffered greatly by a storm, had put into the Cape 
to refit, where they remained five months, surrounded by 
sources of marsh miasmata ; and having already, as we are 
informed by Don Antonio Ulloa, (in the 5th chapter of the 
first book of his Voyage to South America) been grievausly 
attacked by the Yellow Fever, " vomito prieto" before they 
left Cartliagena, we need not wonder that, in this last situa- 
tion, they continued to be afflicted by the same disease, and 
of a form probably more violent than had been previously 
noticed at the Cape : especially in regard to Petechise and 
Hemorrhages, from different parts of the body, proceeding, 
as I conclude, from a scorbutic disposition to which sailors, at 
tli at time, were almost invariably subject, especially after 
long voyages. Here they expended great sums of money, 
and thereby enriched many of the inhabitants, but, like the 
Oriflamme, at Martinico, they were accused of introducing, 
at Cape Francais, a new pestilential fever: " On pretend," 
says the author of the manuscript in question, (p. 205) " qu'elle 
occasionna Tcsp ce dc mat pestilcntiel qui a long terns regne 
dans le Cap, & que Pon traitait faussement du worn de Maladie 
de Siam" &c. At p. 432, M. Bourgeois, in a " Memoire," 
written by himself, 6 \ sur lcs maladies les plus communes u 
St. Domingue," reverting to this event, observes, that " Le 
nom de Maladie de Siam vint a Pesprit de quelqu'un, a cause 
d'une espece de resemblance dans la malignite ; aussitot cela 
se repandit, & cette denomination impropre, est demeuree aux 
fievres malignes, tres communes dans ce pays-ci. Les plus 
inal fesaiites, s'attachent principalement aux Tiouveaux ar- 
rives," kc. He then proceeds to mention the most remark- 
able symptoms of these fevers, especially the violence of their 
first attack, with a strong determination to the head, inflamed 
appearance of the face, yellowness of the skin, and profuse 
J^morrhages from various parts of the body, and sometimes 
even through the pores of the skin. He adds, p. 434, that all 
the fevers of St, Domingo are of the same kind, and nearly 



236 

related to the intermittents, double tertians, and continued 
fevers, with or without exacerbations, (" avec redoublemens, 
ou sans redoublemens") in Europe. 

The name of Maladie de Siam having been thus applied to 
the most violent form of marsh fever in St. Domingo, it was 
adopted by M. Poupee-Desportes, a physician of great merit, 
who arrived there in the following year, and, during the 
fourteen succeeding years, kept an account (founded on accu- 
rate observations) of the weather and diseases, as they oc- 
curred first at the Cape, and afterwards at Fort Dauphin, by 
which it was acertained, that the prevalence or absence of 
Yellow Fever, at those places, invariably depended upon the 
changes of season or constitution, in regard to heat and 
moisture, especially during the summer and autumn. Thus 
at the Cape, in 1733 and 1734, after very copious rains, ex- 
tremely hot and dry weather commenced, and lasted during 
the summer and autumn, inducing a violent Yellow Fever, 
(" Mai de Siam"/ which reigned exclusively for the space of 
four months, and carried off more than half of tbc new comers 
and sailors 5 while there was very little sickness in the more 
elevated country situations. Again in 1739, 1740, 1741, and 
1743, after extremely hot and dry weather for a considerable 
time, the Yellow Fever again became prevalent, and fatal to 
a great part of those who were attacked by it, and who. as 
usual, were chiefly strangers. On the other hand, the tem- 
perature in 1735, 1736, 1737, 1738, and 1742, was mild, or, 
at least, moderate ; and, in those years, this fever only oc- 
curred sporadically, and with diminished violence, so that 
most of the new comers, who were attacked by it, recovered. 
Mr. Poup-e-Desportes also observed, that when this fever 
prevailed as an epidemic among strangers, and in its more 
violent forms, at the Cape, and at Fort Dauphin, it affected 
the seasoned inhabitants only as a mild bilious remittent, or, 
as he called it, a lymphatic fever. From this constant de- 
pendance of Yellow Fever upon the state of wcath er, this 
author infers that it ought to be regarded *• comme une dt 



237 

maladies dont il faut chercher la cause dans la constitution de 
Pair "f and, consequently, not as produced by contagion. See 
Histoire des Maladies de St. Domingue, torn. 1. p. 191. 

I ought here to mention, according to the information given 
by M. Valentin, formerly " Premier medicin des Armees de 
St. Domingue, &c. at p. 58 and 59 of his Traite de la fievre 
jaune d'Amerique, that, in the French West Indian colonies, 
and especially since the time of Poupee-Desportes, a distinc- 
tion has been made between " la inaladie de Siam, and la 
fievre jaune," which last was known under the denomination 
of " fievre ardente maligne, ou fievre bilieuse maligne ;" 
and sometimes under that of " la Matelotte." That these 
diseases were " identiques," or, at most, only presented a 
variety in their effects. That the name Mai de Siam was 
given when the signs of dissolution of the blood were present 
in the highest degree, (" au Comble") when, besides a jaun- 
dice, the blood became extravasated under the skin, making 
its way through different natural outlets or passages, and 
transuding by the pores at some points of the cuticular sur- 
face, (par les pores de quelques points de la surface cuticu- 
laire.") It seems probable, therefore, that this distinction, 
and this application of the name Mai de Siam, were derived 
from an unusual prevalence of Hemorrhages and Petechias, 
observed in the crews of the Oriflamme, at Martinico, and of 
ihe Spanish squadron, at St. Domingo, when labouring under 
the Yellow Fever; and that, in both cases, there was, as 
might well be expected in such long voyages, and at those 
ti iies, a great predisposition to scurvy, or to a dissolved state 
of the blood, in the persons so affected ; though Hemorrhages, 
&c. have occurred not unfrequently in other situations to per- 
sons under Yellow Fever, and sometimes when there was no 
appearance of a scorbutic disposition. 

Unfortunately, this account of the weather and diseases at 
St. Domingo was not continued by any other physician after 
the death of M. Poupee-Desportes : though it appears from 
M. Valentin's Treatise', that the French physicians at St. 



23S 

Domingo had generally thought the Yellow Fever to be not 
contagious, and that this was also his own opinion. 

Of the Yellow, and other marsh fevers, as they affected the 
British army at St. Domingo, during the late war, a very 
good account has been given by Dr. Hector M'Lean* to which 
I must refer those of my readers who wish for more ample in- 
formation on this subject : only observing that, he also deli- 
vers it as his decided opinion, that " what has been called 
Yellow Fever there, is not an infectious disease ; that it is tin- 
common remittent endemic of that country," applied to the 
English or European constitution." This opinion is repeat- 
ed almost in the same words, at p. 71, and again at ]». 
where he says, " there is no point on which I am more de- 
cided than the absence of contagion in the remittent of St. 
Domingo ;" and this he declares to have been the opinion of 
Dr. Scott, Dr. Wright, and Dr. Gordon, (all plrysiciui 
the St. Domingo Staff,) and of every medical man with whom 
he conversed at that island.* 

In regard to the fever which destroyed the army under 
General Leclerc, at St. Domingo, in 1802 and 1803, I must 
refer my readers to M. Gilbert's Histoirc Medicale. only ob- 
serving that he also declares it not to have been an imported 
disease, but to have originated in an atmosphere extrcmeh 
heated, and filled with, marsh effluvia (*' elle a son origine 
dans un air tres-chaud, sature d'emanations marccageus 



* Dr. Jackson, w ho was also on the Hospital-staff at St. Domingo, has delivered 
similar opinions in his Outline of the History and Cure of Fever, kc. ; in which he 
states the endemic fevers of the West Indies to he produced by exhalations from the 
surface of the garth, and that, " though they often destroy I 

of propagation in the patient,*' — " that they may become epidemic, but not conta- 
gious." Of their varieties, he says, " the disease, in the more violent forms, is, or ap- 
pears to be, continue d, in some situations; in others it is remitting, and of regular 
tvpe. In wet weather, and on swampy grounds, the endemic of d St. Do- 

mingo] is usually remitting in form; and, under this form, exhibits appearances of 
jaundiced yellowness, of black vomiting, purgings of black matter, hamorrlta^ 
different parts of the body, petechia, Undoes*" Sec. 



239 

p. 93. He adds, in the next page, that it is not contagious ;# 
and that this is the opinion of the generality of Practitioners. 
— But, that it is epidemic for almost all new comers; and a 
tribute which must commonly be paid by them within the first 
year after landing. And having asked, at p. 77, whether the 
Fellow Fever be a disease, from the bilious (or marsh) fevers, 
he answers, " il y a tout lieu de croire qu'elle n'est autre 
chose que le maximum des ficvres remittentes bilieuses," i. c. 
there is every reason to believe that it is only the highest or 
most violent form, of bilious remitting fevers. At p. 80, M. 
Gilbert advises those who are under the necessity of living in 
the city of Cape Francois, to remove from the shores of the 
sea, and especially from the environs " de L'embouchure de 
la rivi-re du haut du Cap; lieux ou la brise de terre porte 
chaque jour les Emanations marecageuses de cctte surface im- 
mense de lagons, qui s'etendent de L'embarcadere de la Petite 
anse, au bourg du haut du Cap." 

The fust epidemic fever, in Jamaica, of which I have found 
any account, is that mentioned by Dr. Trapham, in a little 
volume, entitled, " State of Health of Jamaica," printed in 
1679, about twenty -four years after the capture of the island 
by Cromwell's forces. In this volume the author, after re- 
presenting Jamaica ay not liable to any pestilential or epi- 
demical disease, adds, p. 81, — " I know it hath been com- 
monly received, that, about eight years since, when the vic- 

* It must be observed, tint M. Gilbert delivers this opinion that the Yellow Fever 
is not contagious with a sort of qualification ; because he supposes that, when great 
numbers of patients, under this putrid gangrenous disease, as he calls it, are collected 
together, the emanations from their bodies may excite fever in persons who are con- 
stantly exposed to them, and also exposed to the causes which originally produced the 
fever;" ("a Taction des causes qui la font naitre") but these causes (miasmata) must 
be sufficient alone, and the emanations from the sick must, therefore, be superfluous. 
He had observed that the attendants on the sick in hospitals at the Cape, were fre- 
quently attacked with the fever; but, as this was the case of almost every one out of 
the hospitals also, and, as the hospitals were, according to his own statement, placed in 
the most unwholesome part, of the town, (whence he says they ought to Ik removed) 
it would have been extraordinary indeed, if persons, by remaining in them, had ' 
escaped the* disease. 






240 

forious fleet returned from the signal Panama expedition, that 
then they brought with them an high, if not pestilential fever, 
of which many died throughout the country. But, this being 
a foreign distemper, brought from abroad, the causes of which 
I could not so well judge of, I am not as yet forced from my 
opinion thereby, but conclude Jamaica more happy than to be 
annoyed therewith, directly and originally" 

Dr. Trapham here alludes to the famous expedition under 
Henry Morgan, who, at the head of about 1200 Bucaneers, 
took Panama, in 1670, and returned to Jamaica with so much 
plunder that his own share amounted to 400.000 dollars. 
With this he became a planter, was made Lieutenant-Govern- 
or of the island, and knighted. Of the fever, with which 
these men were affected, at and after their return, I can find 
no distinct account ; but, as in their march across that part 
of the continent, they must have been almost continually ex- 
posed to marsh effluvia, and, after their return, with so much 
wealth, would naturally have run into debauchery and intem- 
perance of all sorts, there can be no difficulty in finding suffi- 
cient causes to produce among them even the most violent 
fevers in that climate. That marsh fevers have subsequently 
prevailed at Jamaica, to great and fatal extent is but too cer- 
tain ; though distinct and accurate accounts of them we 
wanting; at least, I have found none anterior to the E- 
on Yellow Fever, by Dr. John Hume, who, for many ye 
had the direction of the Royal Marine Hospital, at Jamaica, 
and was afterwards commissioner for the sick and hurt of the 
Royal Navy. This gentleman computes that in 1741 and 
1742, after the return of Admiral Vernon's fleet, from the un- 
successful attempt upon Carthagena, 11,800 sick weir sent 
to the Royal Hospitals of Jamaica, and that, of this number, 
not less than 7000 were attacked with the Yellow or bilious 
Fever. " Of these (says he) I used to compute that 1500 
died, that is something less than one in four : but. in thi>*. I 
pretend not to be exact." See Dr. Hume's E^s,n . in the 



241 

volume on West India Diseases, published by Dr. Donald 
Munro. 

Dr. Williams, in his Essay on the Bilious Yellow Fever of 
Jamaica, (which Essay occasioned a duel between the author 
and Dr. Bennet, and the deaths of both) says, this disease, 
at the time of the expedition to Carthagena, was " so gene- 
ral and fatal, that people looked upon it as a plague, and 
shunned the sick as they would contagion." It does not ap- 
pear, however, that he, or any well-informed medical man at 
Jamaica, then believed it to be contagious. On the contrary, 
Dr. Hume says, (p. 238) *' we have undoubted proofs that the 
disorder is neither a plague nor contagious, as Dr. Warren has 
alleged." He observes, that it commonly made " its attack 
after hard drinking, violent exercise, dancing, and sleeping 
in the open air ; that " strong muscular men are most liable 
to it, and suffer most f* that " Creole white men are rarely 
seized with it ;" that he u never knew any Creole white wo- 
men ill of it;" but has known it prove fatal to European 
white women, though " they are not so liable to it as the 
other sex." He adds, " I have never seen any negro, male or 
female, native or foreigner, attacked with the bilious fever," 
p. 237 and 238. In all these particulars the fever at Jamai- 
ca appears to have agreed with wliaf has generally been ob- 
served of yellow and other marsh fevers. It appears also, 
that many of the cases which fell under the care of Dr. Hume, 
were extremely exasperated, and attended with vomitings 
H of a coffee colour," as well as " black," and with a mortifi* 
cation of the stomach, which, he says, was always found after 
death, " in all such subjects as I have either opened myself, 
or seen opened by others, after having had black vomiting." 
Seep. 217. 

Dr. Lind, in his work on Preserving the Health of Sea- 
men, says, that the Lords of trade and plantations wishing to 
ascertain, for a particular purpose, whether the Yellow Fever 
of Jamaica was contagious or not, " a physician was consult- 
ed^ who had long practised in that island, who gave it as his 

31 



242 



opinion, that from the Yellow Fever of that island there was 
no infection " This (he adds) was not only the opinion of 
that gentleman in the court, but is the belief, as I am in- 
formed, of the best practitioners in that island, and also of 
Dr. John Eliot," (since Sir John,) " a skilful physician in 
London, of Mr. Nasmyth," (Surgeon to Admiral Holmes, 
of Jamaica) " and many others, who have had opportunities 
of being well acquainted with the diseases of Jamaica." See 
p. 292, 3d edit. 

Of similar import is the testimony of the late Dr. John 
Hunter, as delivered in his excellent work on the Diseases of 
the Army in Jamaica, in which, at p. 83, he declaims him- 
self 6i able to say with certainty, that it, (the Yellow Fever,) 
is not infectious." He adds, " in the Military Hospitals, the 
sick, admitted with fevers, were above three quarters of the 
whole ; and they were often much crowded together, yet there 
was no reason to believe that a man, with any other com- 
plaint, ever caught a fever in the Hospital." This testimony 
has, indeed, been repeatedly given, though not in the same 
words, by Dr. Hunter, in different parts of his work. 

These facts and opinions might probably be thought suffi- 
cient in regard to the Yellow Fever at Jamaica, had it not 
been supposed by some persons that a malignant pestilential 
fever was introduced at that island, from Grenada, in 1793, 
and there mistaken for Yellow Fever : to ascertain the fallacy 
of this supposition, it may not be improper to adduce the tes- 
timony of Dr. Lempriere, now physician to his Majesty'fl 
forces, who was then employed in that island. This gentle- 
man, at p. 22 and 23 of the 2d vol. of his Practical Observa- 
tions on the Diseases of the Army in Jamaica, says of the 
Yellow Fever, that it became so prevalent, and proved so 
fatal in Jamaica, during the years 1793, 1794, and 1795, as 
to give rise to a very general opinion, that it was highly infec- 
tious, and that it had been imported from the windward 
islands by contagion." — " But, to those who understand the 
influence of contagion, it will appeal*, that this disease did 



243 

not prevail as if it were of such kind ; for it chiefly affected 
the newly-arrived European, as yet unnerved by the climate, 
whose high health alone rendered him subject to its ravages 5 
while the delicate and weak persons, particularly liable to the 
influence of contagious diseases, were altogether exonerated 
from this fever." The same author, at p. 29 and 30, posi- 
tively denies the existence of any contagious property in this 
fever ; adding, p. 31, that it did not spread generally over the 
island as a contagious disease would have done, in the then 
existing circumstances ; but " was confined to those situations 
only where remittent fevers are most prevalent and fatal, and 
to those subjects who had lately arrived from Europe with ro- 
bust and plethoric constitutions." At p. 47, Dr. Lempriere, 
to account for the occurrence of this fever, with uncommon 
violence in 1793, mentions that the rains usual in the month 
of May were then excessive, and that they were followed by 
very extraordinary heat in June, July, and August; which 
naturally occasioned a more copious and more concentrated 
exhalation of miasmata, than in former years ; and as a much 
greater number of persons arrived about that time from Eu- 
rope, in consequence of the war, the violence of the fever, and 
the numbers attacked by it, were very much increased, as 
might well have been expected ; though it attacked none who 
had long resided at Jamaica, and entirely ceased, as usual, 
about the month of January ; until re-produced by similar 
causes, in the following summer and autumn. 

In a paper concerning the Yellow Fever, which prevailed 
at Jamaica in 1793, 1794, and 1795, read by the late Dr. 
James Walker, to a medical society, which had been formed 
at Port Royal to investigate the nature of this fever, the 
author describes it as attended with a constant propensity 
to vomit, by which mucus and bile were first thrown up ; and 
afterwards, generally about the third day, a matter resemb* 
ling coffee grounds, and sometimes of the colour, consistence, 
and tenacity of tar. Hemorrhages were frequent, from the 
mouth, nose, and, sometimes, from the axilla, anus, and va- 



2U 



gina. Near tlie close of the disease, in those cases which 
terminated fatally, a yellowness appeared, first in the eves, 
and on the neck, gradually extending over the whole body, 
and acquiring a darker hue ; very few had petechial erup- 
tions. In 1793 and 1794, the fever did not intermit, and 
often terminated fatally in two or three days. In 1795, it 
became somewhat milder, and more protracted. It was near- 
ly confined to newly arrived Europeans, though some old re- 
sidents in the interior (and probably high and cool) parts of 
the island, were reported to have been affected by it. The 
author believed the disease not communicable from one per- 
son to another j observing, that "in the public Hospital, 
where many people were necessarily in the same wards, with 
numbers in this fever, neither any of them, nor of the atten- 
dants upon them, were infected." See New York Medical 
Repository, vol. 1, p. 486, 7. 

I shall dismiss this subject, so far as regards Jamaica, b} 
referring my readers to a small, hut very valuable, Treatise 
on the Yellow Fever of that island, by Dr. Grant, a physi- 
cian (as I am informed) of the greatest eminence, and most 
extensive practice there. He considers this fever decidedly as 
not being contagious ; and as being only an aggravated form 
of the remittent of hot climates, exclusively attacking those 
who have lately arrived from colder countries, and who bring 
with them an inflammatory diathesis. He observes, however, 
p. 27, that " in its mildest state, under its clear remitting 
form, it attacks both the long resident and native ?' and that, 
" for several years past," (i. e. previous to 1801) " the native 
and European, of long residence, have experienced it, under 
a greater degree of aggravation of symptoms," than for- 
merly. 

Were I to extend this view to other West-Indian islands, 
and to the Spanish settlements on the continent of America, 
particularly at Carracca, La Guayra, Venezuela, Carthage- 
na, Porto-bello, and Lavera-crux, it would present a repeti- 
tion of nearly similar facts. Believing* however, that a state- 



245 

ment of them would be thought superfluous, and even tire- 
some, I beg leave to direct the attention of my readers to the 
United States of America, where the occurrence of frost in 
winter presents the disease in different circumstances, and 
where the facts, regarding its origin, nature, and supposed 
contagious property, have been, within a few years, atten- 
tively observed, and also discussed with great ability, as well 
as nice discrimination. 

Proceeding, then, from Jamaica northward, Charleston, 
in South Carolina, first offers itself to our observation. And 
here I gladly avail myself of a statement on this subject, 
made by Dr. David Ramsay, of that city, in his u Review 
of the Improvements, Progress, and State of Medicine, in 
the 18th century, already cited at p. 188. The statement 
in question is at p. 39, and in the following words : 

" In the year 1699, a disease prevailed in Charleston, which 
swept off a great part of the inhabitants, and some whole fa- 
milies. This was then called the plague, though afterwards 
supposed to have been the Yellow Fever." * 

In the year 1732, the Yellow Fever began to rage in May, 
and continued till September or October. In the height of the 
disorder, there were from eight to twelve whites buried in a 
day, besides people of colour. The ringing of bells was for- 
bidden, and little or no business was done, f In the year 1739, 

* This disease is mentioned at p. 142, of the first vol. of the History of South 
Carolina, (London, 1779) as having " carried off an incredible number of people;" 
among whom were the chief justice, the episcopal clergyman, the receiver-gene- 
ral, the provost marshal, " and almost half the members of the assembly." In- 
deed, the situation of Charleston, however convenient for trade and navigation, ap- 
pears to have been, from the beginning, eminently productive of marsh fevers in 
summer and autumn. Governor Drayton, in his View of South Carolina, (p 24) 
says, " at its first settlement, Charleston was said to be so unhealthy, in the au- 
tumnal months, that, from June to October, the public offices were shut up, and 
people retired to the country." 

f Dr. John Moultrie, whose father was, during forty years, at the head of his 
profession in Charleston, and who, in 1749, published, at Edinburgh, an excellent 
inaugural Dissertation " de febre maligna biliosa Americas, 4to. after mentioning 
therein, that this disease prevails most violently in proportion as the heat of the at- 



246 

the Yellow Fever raged nearly as violently as in the year 
1732 ; and it was observed to fall most severely on Europeans. 
In 1745 and 1749, (rather 1748) it returned, but with less vio- 
lence; however, many young people, mostly Europeans, died of 
it. It appeared again in a few cases, in 1753 and 1755, but did 
not spread. In all these visitations, it was generally sup- 
posed that the Yellow Fever was imported ; and it was re- 
marked that it never spread in the country, though often carried 
there by infected persons, wJw died out of Charleston, after 
having caught the disease in it." 

" For forty -two years after 1749, there was no epidemic at- 
tack of this disease, though there were occasionally, in differ- 
ent summers, a few sporadic cases of it. In the year 1792. a 
new era of the Yellow Fever commenced. It raged in tliis city 
in that year, and also in 1794, 1795, 1796, 179', 1799, and 
1800. In these last seven visitations of this disease, it ex- 
tended from July to November, but was most rife in Ai . 
and September; with a very few exceptions (chiefly children) 
it exclusively fell on strangers to the air of Charleston, and \\ as, 
in no instance, contagious." 



mosphere is greatest, adds, " in Caroli-op\mlo exeunte mense Junio, ann 
nulla aura per aliquot hebdomadas a stum torrentem refrigerasset, >;tt haec 

t'ebris, et tarn acuta et lethalis erat, ut raultis post diem 2m. vel 3m. moitifera - 
'* Anno 1748, in eodem loco t'ebris \\xc iterum erupit, circa medium mensis \ugnsti, 
prima cujus septimana nulla ibi unquam galidoir erat, ut Mercurius in Fahrenhetii 
thermometro ad 97°, 97 1-2°, et 98°, in aere umbroso ascenderet, et e%lor hicce 
cum multis imbribus diu duravit," p. 8 He adds, at the top of the next page, 
that the atmosphere, sometime after, became cool, and the epidemic, from a Yel- 
loio Fever, changed to an intermittent " a ccli temperie in frigidiorem versa, 
cit et in intermittentem febrim mutabatur." He observes, in the sani- 
though most people thought the fever contagious, he had se*n many persons 
who maintained a close and daily intercourse with the sick, and did not get the dis- 
ease, if they avoided violent exercise, and exposure to external injuries. He s 
6, that the North Americans pretend they derive the disease from the West Indies, 
but that the West Indians say it is not indigenous there. He thinks, bowew 
sufficient causes exist among both ; with and among these causes he includes " ingrns 
xstus aeris," marsh effluvia, violent exercise, drinking to 

&c. He says, the epidemic of i"45 manifestly began from th >c, in a sailor, 

and not from any imported contagion. 






247 

This uncontradicted statement, publicly made by an eminent 
and respectable physician, in the hearing of hundreds, who, if 
it had been erroneous, and particularly if the Yellow Fever 
had manifested any contagious quality in South Carolina, must 
have been able, and disposed, to assert the truth, may well be 
considered as decisive evidence on the subject; especially as it 
was printed at the request of the Medical Society of that state. 
l)r. Ramsay had, indeed, previously stated this fact more cir- 
cumstantially in his address to the same Society, on the 24tli 
of December, 1799, when, speaking of the disease in question, 
as it had appeared there during the preceding summer and au- 
tumn, he says, " We have no reason to believe that the Yel- 
low Fever was either imported among us, or communicated by 
contagion. It raged most in the north end of King Street, 
where the greatest number of persons from the country resided, 
and in those streets where sea-faring persons usually fixed 
themselves. No physician, or nurse, took the disease. Stran- 
gers, who left the city, and afterwards sickened and died in the 
country, were not the occasion of death, or even of disease, to 
those who attended them in their last illness." See New York 
Medical Repository, Vol. 4, p. 100. 

Again, in the Charleston Medical Register, for 1802, Dr. 
Ramsay, alluding to the Yellow Fever, which had then recently 
terminated, declares that " no instance can be recollected in 
which there was any ground to suppose that the Yellow Fever 
was either imported, or had been contagious. No physician, 
nurse, or other person," having " intercourse with persons la- 
bouring under Yellow Fever, caught the disease. It was ex- 
clusively confined to strangers, and among them there was no 
evidence of its being communicated from one to another." 

The like absence of a contagious quality continued to be 
manifested by this disease in succeeding years'. Dr. Ramsay, 
in giving an account of the Yellow Fever, as it had appeared 
at Charleston in the summer and autumn of 1804, (in a letter 
addressed to Dr. Mitchell, and dated the 14th of December, 
1804), writes as follows: — " A few cases of Yellow Fever oc- 



248 

curred prior to the 10th of July ; but, from that day till about 
the 20th of September, it might be said to be epidemic. From 
and after that time it gradually declined, and finally disap- 
peared about the 1st of November." " The weather was un- 
commonly warm, while the epidemic raged, and the number 
and mortality of its subjects increased with the increase of 
heat. The disease was marked with the ordinary symptoms 
which have been so often described, and ai*e so well known as 
to make a new statement unnecessary ; but, in the following 
particulars, an unusual propoi*tion of patients deviated from 
what had been the more common form of the disease in pre- 
ceding years. Neglected intermittents frequently terminated in 
Fellow Fever. The black vomit was neither violent nor con- 
stant, even in fatal cases, where the depleting system was car- 
ried to a proper extent." " As usual, the disease was con- 
fined to persons who were strangers to the air of Charleston ; 
but it attacked some who had resided among us one or two 
years, and, in a few cases, more." But in these there " has 
generally been a great proportion of exciting causes, such ;i< 
intemperance, long exposure to the damps of night, or the 
scorching rays of the sun." This disease, in no instance proved 
contagious." See New York Medical Repository, vol. 8, p. 565. 
I shall conclude these statements, in regard to Charleston, 
by the following extract from Dr. Ramsay's Letter to Dr. 
Miller, dated the 18th of November, 1800, viz. "The disputes 
about the origin of the Yellow Fever, which have agitated the 
Northern States, have never existed in Charleston. There is 
but one opinion among the phy si cans and inhabitants, and that 
is, that the disease was neither imported nor contagious. Has 
was the unanimous sentiment of the Medical Society, who, in 
pursuance of it, gave their opinion to the government last sum- 
mer, that the rigid enforcement of the quarantine laws was by 
no means necessary, on account of the Yellow Fever." a Mv 
private opinion is, that the Yellow Fever is a local disease, ori- 
ginating in the air of Charleston." See New York Medical 
Repository, vol. 4, p. 218 and 219, 



249 

North Carolina having no large city, has been less fre- 
quently infested with the violent forms of marsh fever. But 
Dr. De Rosset, of Wilmington, in that state, has described, 
what he calls a pestilential fever, which prevailed there in the 
autumn of 1796, accompanied with yellowness of the eyes and 
skin ; and " ultimately the true black vomit, as described by 
writers on the Fellow Fever," He describes Wilmington, as 
being much exposed to marsh effluvia, and the weather of that 
summer as having been unusually hot and dry subsequently to 
a very wet spring: Of this fever, he says, " I have no doubt, 
in my own mind, of its having originated among us, nay more, 
of its differing from our common bilious remittent but in de- 
gree ; of its originating from the same causes, and being aggra- 
vated by the circumstances of the season." " I did not observe 
one instance of its being communicated by contagion ; nor do I 
believe it was so." " A few cases every year, of our common 
fall fever, take on all the symptoms of a violent Yellow Fever." 
See New York Medical Repository, vol. 2, p. 143, 4. 

In proceeding northward, our next object will be Norfolk, 
in Virginia, which, being a considerable port, and abounding 
in the sources of marsh miasmata, has, on several occasions, 
been severely attacked with Yellow Fever, as I have already 
noticed, at p. 191. Several of these attacks fell under the 
observation of M. Valentin, who landed in Virginia, with 
many other fugitives, from St. Domingo, in the summer of 
1793, as is mentioned at p. 185 ; and this gentleman, after 
noticing the various attempts made at Philadelphia, to prove 
that the disease in question had been produced by importation, 
says, at p. 84. of his Treatise, " Nous avons vu la Maladie 
commencer a Norfolk, sans qu'on ait pu en accuser aucun na- 
vire recemment arrive : les Medecins de ce lieu n'ont mhne 
jamais eu cette opinion," In the next and following pages he 
observes, that the Yellow Fever never appears there but in 
those months when the air is extremely hot and sultry, with 
but little motion. That, in 1796, the summer was very wet, 
and the Yellow Fever only appeared sporadically ; being 

32 



250 



little more than the common bilious remittent. But, in 1797, 
the drought was extreme at Norfolk, (and, consequently, the 
heat) during the whole of July, August, September, and 
October ; and that the Yellow Fever then raged furiously as 
an epidemic, and with symptoms of unusual malignity, be- 
ginning about the end of August, and continuing until about 
the middle of November, when the weather, becoming cold 
for two or three days, the fever entirely disappeared, as it 
has invariably done in every part of the United States, soon 
after the occurrence of frost. Between pages 92 and 102. 
M. Valentin states a number of facts and reasons, proving 
the local origin of the disease at Norfolk, Ace. and its having 
manifested no contagious property in circumstances where 
such property, had it existed, ought to have become evident. 
He describes the situation of Water Street, at Norfolk, and 
the composition of the new-made ground, as it is called, 
which serves as a foundation to the houses of that street, 
adding, that it is in that part of the town that he has con- 
stantly seen the greatest number of Yellow Fever patients, 
labouring under the disease in its worst forms, with he- 
morrhages, &.c. See p. 101. 

At p. 191 of this volume, I hare inserted an extract from 
an account, given by Doctors Taylor and Hansford, of the 
Yellow Fever, as it prevailed at Norfolk, in the summer and 
autumn of the year 1800 ; and I will hero subjoin extracts of 
another account, given of this disease at the same time and 
place, by Doctors Selden and "Whitehead, two other physi- 
cians of Norfolk, viz. " Europeans and natives of the North- 
ern States, who had not been accustomed to warm climates, 
were most exposed to the attack of the disease in its severest 
forms ; those, from the same countries, who had resided here 
for some time, and strangers from this and the neighbouring 
states, were not exempt, but the disease (in them) put on a 
milder form ; while those who were born in Norfolk, and 
were old residents of the place, never enjoyed a prater portion 
of health, in any former season, none of them died, or were 



251 

even affected with the prevailing epidemic. This entire ex- 
emption of the permanent inhabitants of Norfolk, different from 
what was experienced in more northern parts of America, as 
Philadelphia, New-York, and Baltimore, may probably be 
accounted for, on the supposition that our situation and cli- 
mate here, approach nearer to the circumstances of the West 
India islands, where strangers in general are the only persons 
attacked with Yellow Fever." 

These gentlemen further observe, that, " for more than 
two months, subsequent to the 25th of June," (of that summer) 
" the inhabitants of Norfolk lived in an atmosphere constantly 
heated above the 85th degree of Fahrenheit's scale, and some- 
times to the 94th and 95th degree, but very frequently above 
the 90th." That, u on the 5th of October, a deluge of rain 
fell, accompanied with a powerful sweeping wind from the 
North-East ; the weather became suddenly very cool; the 
mercury fell to 48° on the morning of the 6th, and, on the 7th, 
it was as low as 42° of Fahrenheit. In a/ew days after this, 
not a vestige of Yellow Fever was to be seen in Norfolk." 
The same gentlemen add, " that part of the town, where the 
malignant fever chiefly prevailed, stands entirely on made 
land, reclaimed from the river by sinking pens of large logs, 
and filling them up chiefly with green pine saplins, which are 
slightly covered over with earth, pr gravel. In some places 
large openings are left for the formation of docks ; in others, 
wharves are formed next the channel of the river, while the 
interior parts are still covered with water, and, in many 
others, the lots remain in their original state." They also 
mention other sources of marsh effluvia, which acted upon, as 
they observe, ** by the powerful rays of an almost vertical sun," 
must have been very sufficient to produce this disease, which, 
as they state, " for several weeks, after its commencement, 
was quite local." See New- York Medical Repository, vol. 4. 
p. 129 and seq. 

The same disease prevailed again at Norfolk in 1801, when 
the four physicians, before-mentioned, subscribed a declara- 



252 



tion, dated the 12th of October, 1801, in these words, viz. 
" we do certify that the malignant Yellow Fever, which pre- 
vailed with violence for some time past, has now nearly 
ceased, and that the health of the town appears to be improv- 
ing daily. We know of no instance in which the disease has 
been communicated by contagion." Medical Repository, vol. 5, 
p. 225. 

Baltimore, in Maryland, falls next under our observation. 
In this city, especially at FtlVs Point, or East Baltimore, 
(which is greatly infested by marsh effluvia.) the Yellow Fever 
has several times prevailed, and with great mortality, since 
the year 1793. In a Treatise on this Disease, published in 
1798, by Dr. Davidge, a physician of eminence in Baltimore, he 
states, that in the preceding year, 1797, " the bilious or re- 
mitting fever, in its ordinary form, prevailed in that town, 
and particularly at the Point;- 9 and that this continued u un- 
til it was gradually lost, in the severer degree of Yellow Fercr, 
as the season advanced in the month of August:" that, u from 
this time, until early in November, when it became entirely 
extinct, the Yellow Fever alone was observed ; and it was 
obviously more severe, more early in its occurrence, and more 
general in its prevalence, in the direction of the winds which 
blew over certain marshes, stagnant waters, and depositions 
of filth." He, therefore, considers " intermittents, remit- 
tents, and Yellow Fever, as merely varieties of one disease," 
— asserting " that the Yellow Fever cannot be propagated 
by contagion, out of the sphere wherein it originated." See 
New-York Medical Repository, vol. 2. p. 83, 84. 

Of the epidemic Yellow Fever which occurred at Baltimore, 
in the year 1800, the faculty of medicine of that city, in a 
report to the mayor, say, " after the most scrutinizing in- 
vestigation, the faculty have found no proof, or even cause of 
suspicion, that the fever which lately so unhappily afflicted 
our city, was derived from foreign causes f and, in support 
of this declaration, they give a particular account of thirteen 
cases, in which the disease first appeared, all of whom were in 



253 



persons who had been exposed to marsh miasmata, but had 
not communicated with any vessel, " engaged in foreign com- 
merce ;" and " were attacked at such distances from each 
other as to preclude the probability of any one of them having 
derived it from the other." They proceed, — " the gradual 
manner in which this disease becomes epidemic, is an addi- 
tional proof that it is not derived from foreign sources;" and 
after describing the milder cases which occur at the beginning, 
before the causes acquire full force, they add, " if this disease 
were imported, the prominent features would develope them- 
selves at first, and these precursers, and more mild grades of 
the disease, could not affect thousands on shore, who never 
had any communication with vessels from the West Indies, or 
any diseased body." " The faculty believe the following to 
have been the principal sources of this late malignant fever," 
— First, " the cove which extends from the mouth of Jones's 
Falls to the interior of Fell's Point, the bottom of which was 
left bare, by the recess of the tide, for some weeks, immedi- 
ately preceding the epidemic appearance of the fever. This 
was occasioned by the prevalence of north and cast winds, 
which continued a great part of the summer." " Such is the 
situation of this pestilential cove, that all the filth conveyed 
into it by the west, north-west, and south winds, must remain 
to stagnate and putrefy under a summer's sun." u From the 
united testimony of the physicians at Fell's Point, the disease 
began on the borders of this cove ; and its progress could be 
traced through the streets, in whatever direction the winds 
wafted its poisonous effluvia. Such was the pestilential con- 
dition of this sink of putrefaction, that the labourers, employed 
in filling up its northern shore, were compelled to relinquish 
their undertaking early in the summer." 

" Second. — The docks, in general, but more especially the 
interstices between the wharves, where the water stagnated, 
and afforded a proper matrix for the generation of pestilential 
effluvia." 

They afterwards mention several other causes, of more 



254, 



limited operation, such " as stagnant water retained in cel- 
lars," " ponds, and low grounds in the city, and its vicinity;" 
— and, finally, " the made grounds, of which the wharves, 
and the lower parts of some of the streets, are formed," and 
then conclude, — " from these sources we derive the first cases 
of the late fever, and, from these, fomented by the summer's 
sun, we believe it to have become afterwards epidemic. We 
are more strongly impelled to ascribe our late malignant fever 
to these causes, from having ascertained tbat it did not exist in 
the higher parts of the city, remote from exhalation, unless it 
had been carried there from the Point, or from the lower pails 
of the city." 

The course I have taken leads us next to Wilmington, on 
the river of Delaware, situated on a spot which gradually 
rises to the height of 109 feet, as it recedes from the river of 
Delaware, between which, and the town, is an extenshe 
marshy low flat, more than a mile wide. On two other sides, 
it is bounded by two large streams of water, called Christiana, 
and Brandy-wine creeks ; and by the side of the first is an 
extensive marsh, which, in the spring of the year 1T98, was 
drained for the first time, so that a surface of 100 acres of 
mnd were in the following summer, exposed to the sun, which 
produced very offensive exhalations ; and, in consequence of 
these, the Yellow Fever, with its most violent symptoms, be- 
came generally prevalent in September of that year, in the 
lower parts of the town, and occasioned the deaths of above 
200 persons in that quarter ; whilst the more elevated n 
were almost wholly exempt from the disease. Dr. John 
Vaughan, who has given a minute account of this fever, in 
the 3d volume of the New- York Medical Repository, at p. 
368 and seq. and who had previously believed the Yellow 
Fever to be a foreign and a contagious disease, was induced, 
by the facts which then fell under his observation, to adopt 
the contrary opinion. Here was abundant evidence to prove 
that the disease had arisen solely from the noxious exhalations 
to which the lower part of the tov>n was particularly exposed : 



255 

and he could not discover a single instance in which the fever 
had been communicated to any person who had not been with- 
in the reach of these exhalations. 

This fever again recurred at Wilmington, in September, 
1802, subsequently to an interval of very hot weather, which 
began about the middle of August, and in which the tempera- 
ture varied from 80° to 96° of Fahrenheit's thermometer, as 
is stated by Dr. Vaughan, in his "Concise History" of 
this fever, printed at Wilmington, in 1803 : according to his 
statement, "the sources of noxious effluvia in the southern 
And flat part of the town were much increased by a regulation, 
but partially executed, for bringing the streets to an uniform 
descent from the summit of the hill. A number of cellars 
were filled with water ; a new dock formed, and the gutters 
lowered in some places, and raised in others, forming nume- 
rous depositories of filth." " The fogs (says he) collected in 
the evenings, were suspended on the flats during the nights.'* 
"This semi circuit of the fogs, from Market Street southward 
and eastward, was the seat of concentrated disease." — " The 
poisonous matter exciting disease, was evidently a constituent 
part of the fogs. Many persons visited the infected district, 
in clear weather, and in the day-time, without injury ; and 
several of the same persons contracted disease by a single ex- 
posure in the night time, after the fog had collected." " The 
non-contagious nature of the disease was repeatedly attested, 
by persons sickening after removal, from the lower to the 
higher parts of the town, and being nursed with every atten- 
tion, and dying without communicating the malady to their 
attendants." He adds, " the indigenous nature of the disease 
was evidently characterised, by the ultimate sameness of eve- 
ry form and grade of fever. After the middle of September, 
the subordinate forms and grades of fever, not arrested within 
48 or 72 hours, invariably passed on to the malignant grade of 
the disease." There was a final termination of its progress 
" by a single frost. 9 ' 



256 

Philadelphia falls next under our observation. This city 
was originally intended to occupy the fiat space of ground be- 
tween the Delaware and Schuylkill Rivers, a few miles above 
their junction : it has, however, been found more convenient 
to extend it to a greater distance along the west bank of the 
Delaware, under which bank, upon a low space of ground, 
originally intended as a cartway to the wooden wharves 
which abut and encroach upon the bed of tin river, an exten- 
sive street, called Water- Street, lias been formed, extending 
from the northern line of the city, southward to the swampy 
ground given by the founder, William Pcnn, to be formed into 
a dock, which, not being done, and the exhalations from this 
swamp proving noxious to the inhabitants, it lias been arched 
over, and covered with earth, so as to become the foundation 
of a street, called Dock Street, near which an offensive sewer 
empties itself into the Delaware. 

The ground between the southern extremity of the city, of 
rather of the suburb, called Southwark, and the junction of 
the Delaware and Schuylkill, is generally very low, rich, 
and damp, I might say swampy in many places : and, appa- 
rently, is as well suited to produce marsh miasmata as any 
part of Zealand, and with greater morbific powers, because 
the summers at Philadelphia are much hotter. On the north* 
ern extremity also, in and about the suberb called Kensington, 
are low swampy grounds, of considerable extent : and a great 
part of the city itself stands upon a loamy, or brick earth, 
which is very impenetrable to water. Thus situated, it can 
hardly be necessary to observe, that Philadelphia has been 
frequently infested by marsh fevers, though it is not known 
that, previous to the year 1793. they assumed epidemically the 
violent form of Yellow Fever, except in the years 1699. 1741, 
1747, and 1762.* The great mortality which the Yellow 



* Dr. Uush, in the 4th vol. of his Medical Inquim -. r> to a cli- 

nical lecture, delivered December 3d, 1766, at the Pennsylvania Hosn.tal. bv the 
late Dr. Thomas Bond, and preserved by order of the managers, in tin 
their Minutes, in which he declares, "that he had seen the Yellow Fever/tr times 



251 

Fever produced in 1793 at Philadelphia, is well known. 
From the great numhers attacked by it, at that time, and 
the influence of pre-existent opinions on the subject of conta- 
gion, the physicians, as well as the inhabitants, seem to have 
immediately, without enquiry or consideration, concluded 
that it must be a contagious disease, and most of them in- 
ferred, as a natural consequence, that it had been imported 
from some part of the West Indies ; though there was much 
disagreement in regard to the particular vessels, chargeable 
with this importation, as well as in regard to the places whence 
it liad been brought; — some deriving the evil from Grenada, 
others from different ports of St. Domingo, &c. On that oc- 
casion Dr. Rush, dissatisfied with the contradictory evidence 
about the importation of the disease, though he admitted it to 
be contagious, and, consequently, capable of importation, 
thought he had discovered a more probable cause for its pro- 
duction in a cargo of damaged or putrefying coffee. Thus 
overlooking the influence of marsh miasmata, which ought, at 
least, to have been strongly suspected, considering that the 
fever began in Water Street, and afterwards appeared in 
houses adjoining other swampy grounds near Dock Street, 
Kensington, and Southwark ; and considering, also, that it 
resembled a marsh fever in almost every circumstance, es- 
pecially in the season at which it appeared ; in the evident 
remissions with which it was attended ; in the circumstance 
of its leaving unhurt all the French fugitives from the West 
Indies, and others who had long resided in hot climates ; and, 
in its cessation immediately after frost. 

At the commencement of this disease, M. Bercese, late Sur- 
geon-General of the troops, in the northern division of St. 
Domingo, who had long practised at Cape Francais, having 
escaped from the ruins of that city, reached Philadelphia, and 
though the Physicians there had generally declared the fever 

in Philadelphia. The second time it was indigenous, from evident causes, and wai 
confined to one square of the city." Upon this Dr. Rush remarks, that "the locay 
fity of this fever designates its putrid origin," i. e. from marsh effluvia, 

33 



258 



to be a contagious disease, he honestly and courageously 
maintained the contrary, and ascribed it, exclusively, to local 
causes, probably without making any converts to his opinion 
at that time,' but the committee of superintendance, and the 
physicians, willingly availed themselves of his experience in 
the treatment of the disease, so far as to intrust him with the 
direction of the spacious Hospital at Bush Hill, which had 
been just established for patients under the Yellow Fever ; 
and in which his practice was attended with great success, 
perhaps, in some degree, from its salubrious situation. In 
the following year, M. Devese published, at Philadelphia, a 
Dissertation on the Yellow Fever of the preceding year, (in 
that city) stating his reasons for believing the disease to have 
been neither imported nor contagious ; which, though not so 
conclusive as we can now give, probably helped to induce 
some, at least, of the physicians there to inquire and think, 
with greater freedom, on the subject. For in 1796, Dr. 
Rush, when giving an account of this fever, as it occurred in 
1794, (though much less extensively than in 1793) would not 
admit contagion to be one of its characteristic marks ; deeming 
this quality to be rather accidental, and to depend on circum- 
stances of season, country, &c. ; and, on this occasion, he ap- 
parently, for the first time, ascribed the fever to exhalations 
from gutters, and stagnant ponds of water, in the neighbour- 
hood of the city ; having observed, that u where there was 
most exhalation, there were most persons affected by the fe- 
ver." See his Medical Inquiries and Observations, vol. 4. 
p. 63. 

In the month of November, 1797, Dr. Rush, Dr. Caldwell, 
and eleven other physicians, of Philadelphia, whose opinions, 
respecting the Yellow Fever, were now at variance with those 
of a majority of the College of Physicians there, being called 
upon by the governor of Pennsylvania to state, for the infor- 
mation of its legislature, the results of their researches and 
experience, respecting the " origin, progress, and nature," 
of the epidemic Yellow Fever, which had then just terminated, 



259 

(on the occurrence of frost,) these gentlemen, in their answer, 
say, " we conceive the fever, which has lately prevailed in 
our city, commonly called the Yellow Fever, to be the bilious 
remitting fever of warm climates, excited to a higher degree 
of malignity by circumstances to be mentioned hereafter f 9 
and they allege the following, among other reasons, for this 
belief, viz : 

1st. That both fevers have a similar origin. 

2d. That the Yellow Fever occurs in " those months 
chiefly in which the bilious fever usually prevails, and is uni- 
formly checked and destroyed by the same causes, viz. heavy 
rains and frosts." 

3d. That " the symptoms of the bilious and Yellow Fe- 
vers are the same in their nature, and differ only in degree." 

4. That the common bilious and Yellow Fevers often run 
into each other, 6cc. 

5. But after having made these approaches to the truth, 
they state, as another reason, that " the common bilious and 
Yellow Fevers are alike contagious, under certain circumstances 
of the weather, and of predisposition in the body > M * Not 
suspecting it to be impossible that contagion should ever be 
either acquired or lost by the presence or absence of such cir- 
cumstances. In the following year, the same physicians and 
others, being then incorporated as u the Academy of Medi- 

* It deserves here to be remarked, that while Dr Rush and his associates thus 
erroneously represented the common bilious, as well as the Yellow Fever, to be some- 
times contagious, the College of Physicians, in their answer to the governor of Penn- 
sylvania, dated December 5, 1797, state, as their principal reason for believing 
the two diseases to be essentially different, " that a malignant remittent lever has 
never been, to our knowledge, contagious in this climate." They had, immedi- 
ately before, admitted the occasional existence of " solitary cases of malignant re- 
mittent fevers, the symptoms of -which resemble so much the disease in question, (Yel- 
low Fever) that they are very often supposed to be the same" Hence we see, 
that to raise up a baseless distinction between these fevers, the College, after ad- 
mitting one to be void of contagion, assume the other to possess that property, 
though without proof and at a time when, except among the physicians in Philadel- 
phia, there was not one in twenty of those who had seen the disease ia other 
parts of the United States, that believed what was thus assumed. 



260 



cine of Philadelphia," were again called upon by the gover- 
nor, In regard to the Yellow Fever of the preceding summer 
and autumn, (of which 3648 persons were computed to have 
died at Philadelphia, exclusive of many who fled and died in 
the country,) and they declared, in their letter, dated De- 
cember 3d, 1798, "that the disease is not contagious in the 
West Indies, and rarely, if ever, so in the United States, in 
liot weather, at which time only it makes its first appearance in 
our country. So general (they add) is this opinion, that some 
physicians have unfortunately refused to admit the existence 
of the fever in its commencement in our city, only because it 
was not contagious." Here was a farther approximation to 
truth, made by these gentlemen ; and it is probable that they 
would have then completely renounced all belief of the suppos- 
ed contagion of Yellow Fever, had not their doing so been op- 
posed by Dr. Rush, whose mind had been so strongly biassed 
in favor of that belief, that he could not relinquish the notion 
of an occasional or accidental occurrence of that quality until 
very many proofs, in opposition to it, and those of the in<>*>t 
decisive nature, had been presented to his consideration. At 
length, however, he obtained the fullest conviction on the 
subject, and announced it by a long statement of " facts, in- 
tended to prove the Yellow Fever not to be contagious," &c. 
" In a letter to Dr. Edward Miller,- published in the New 
York Medical Repository, vol. 6, p. 135 to 150. Towards 
the conclusion of this statement are the following passages, 
viz : 

" You will perceive, from the facts and reasonings contain- 
ed in this letter, that I have relinquished the opinion published 
in my account of the Yellow Yever, in the years 1793, 1794. 
and 1797, respecting its contagious nature. I was misled by 

Dr. Lining, and several West India writers," 6cc. u I am 

aware of the influence which such changes in medical opinions, 
as I have acknowledged, have, upon a physician* s reputation : 
but small, indeed, should I consider the total sacrifice of mine. 
could it avert the evils which are connected with a belief in 



261 

the importation of pestilential diseases," &c. Not content 
with having done this, Dr. Rush, in the preface to a subse- 
quent edition of his Medical Inquiries and Observations, 
made the following declaration, and caused it, moreover, to 
be inserted in the Medical and Physical Journal, No. 85, and 
in other periodical works, viz. 

" In the 4th volume the reader will find a retraction of the 
author's former opinion of the Yellow Fever spreading by 
contagion. He begs forgiveness of the friends of science and 
humanity, if the publication of that opinion has had any in- 
fluence in increasing the misery and mortality attendant upon 
that disease. Indeed, such is the pain he feels, in recollecting 
that he ever entertained or propagated it, that it will long, and, 
perhaps, always deprive him of the pleasure he might other- 
wise have derived, from a review of his attempts to fulfil the 
public duties of his situation." 

And here I must observe, that if the conviction of any one 
man can reasonably influence the opinions of others, on this 
subject, the preceding declaration, by Dr. Rush, ought to pro- 
duce that effect ; made as it was, not precipitately or capri- 
ciously, but with slow and cautious deliberations ; not from 
the impulse of former prejudice, but in direct opposition to it ; 
not from a vain desire of appearing to be infallible, by vindi- 
cating opinions inconsiderately promulgated, but with a con- 
scientious and humble, (I had almost said humiliating) purpose 
of condemning and renouncing such opinions, and of atoning 
for them, if necessary, even by the sacrifice of his reputation, 
at the shrine of truth. I flatter myself, however, that no loss 
of reputation has been incurred by this proceeding. To me 
Dr. Rush appears as being more estimable after this honest 
avowal of an error, than he would have been, had he never 
fallen into it : and I earnestly hope, that in similar circum- 
stances, I should, most willingly, follow his example. 

When Dr. Rush thus denied the supposed contagion of Yel- 
low Fever, he had probably seen more of that disease than 
any other physician in any country : and if the many thou- 



262 



sands of cases of it, which fell under his immediate observa- 
tion, and the still greater number of which he was doubtless 
informed, not only did not afford any such evidence of con- 
tagion, as, with the aid of his prepossessions, could maintain 
him in his former belief on that subject, but, on the contrary, 
manifested so unequivocally a total absence of any contagious 
quality, as, in spite of these prepossessions to impel him to 
make the declaration before-mentioned, who that supposes Dr. 
Rush to have possessed common intellect and discernment, 
will believe the Yellow Fever to be contagious ; tmless he 
knows it to be so by unquestionable facts within his own ob- 
servation, and of the most decisive import. Facts, such ;i^ 1 
believe to have never existed, in regard to this disease. 

Numerous statements, concerning the origin, progress, and 
nature of the Yellow Fever, at Philadelphia, in different years, 
are now before me ; all agreeing in the most important points 
with those which I have recently introduced, concerning its 
appearance at Charleston, Norfolk, Baltimore, kc. and, there- 
fore, lest I should exhaust the patience of my readers, I will 
only select a few passages, from a lecture, introductory to a 
course of clinical lectures, delivered at the Infirmary of the 
Public Alms House, in Philadelphia, by Charles Caldwell. 
M. D. respecting the Yellow Fever, as it occurred there, 
in 1803. 

After various preliminary observations, together with an 
account of the very sultry, humid atmosphere, which prevail- 
ed at Philadelphia during the month of July, and excited 
many distressing apprehensions, (the thermometer commonly 
indicating a temperature between 80 and 90) Dr. Caldwell 
mentions two cases of disease, which appeared on the 19th of 
that month, " in adjoining houses at the corner of Chesnut 
and Water Streets ; and were but too well calculated to realize 
and confirm these melancholy anticipations." These a 
were those of two " females, under the age of sixteen years : 
one of whom died on the 5th day of her illness, and the other 
recovered ; but they both exhibited unequivocal symptoms of 



263 

malignant fever.* It is worthy of remark, that, adjoining to 
the houses where these persons resided, were a yard and pri- 
vate alley, containing stagnant water and putrid substances, 
which, for a week or ten days previously, had emitted a smell 
highly offensive to the neighbourhood. The families where 
the sickness occurred, did not hesitate to attribute their mis- 
fortune to this insufferable stench." " From the 28th of July, 
till the 5th or 6th of August, four other cases of malignant 
fever appeared in the same neighbourhood, three of which 
terminated fatally." These persons had not " the slightest 
intercourse with each other, nor with any common source, ex- 
cept the atmosphere of the place where they resided. A know- 
ledge of this induced most of our citizens to consider this 
disease as nothing else than a high grade of autumnal fever, 
or, what was afterwards very emphatically denominated the 
Water Street fever." Another " very decided case (of malig- 
nant fever) made its appearance in the person of Mrs. Cole, 
on the 23d, and terminated, in death, on the 27th of July." 
She " resided in Water, near South Street, upwards of a 
quarter of a mile from the former situation, and had not 
been out of her own neighbourhood for several weeks pre- 
viously to her illness." 

" There existed another point where malignant fever threat- 
ened at the same time to attack us. Tfiis was in Water, near 
Race Street, about a quarter of a mile in an opposite direc- 
tion from Chesnut Street." " Mr. Jolly, of that neighbour- 
hood, sickened on the 28th, and died on the 31st of July, 
with symptoms of high malignity. Between the 1st and 10th 
of August, six other persons, in the same neighbourhood, 
but who had no intercourse with each other, were attacked 
by the disease, one of whom died on the 4th day of his ill- 
ness : the others all recovered." In none of these cases was 
the fever communicated to any other person. 



* It will, doubtless, have been already observed, the terms Yellow Fever, and 
Molignant Fever, are used by the physicians of the United States as synonymous. 



264 

* As yet all parts of Philadelphia, except Water Htreet, 
which must be regarded as the low ground of the liver Dela- 
ware, enjoyed an unusual exemption from disease."* " On 
the 12th of August we had a heavy fall of rain, which was 
succeeded by a remarkable change in the temperature of the 
atmosphere, the mercury sinking ten degrees," by a preva- 
lence of northerly winds for ten days, during which M the 
city remained free from any further cases of malignant dis- 
ease." 

" On the 23d of August the wind shifted to the southward, 
and the atmosphere became humid, warm, and oppressive. 
This change was viewed by many as a precursor of further 
sickness." " On the morning of the 25th, a dreadful fire 
broke out in Water, near Market, Street," and " drew to- 
gether a vast concourse of people. Of these some were en- 
gaged in violent exercise, while others were standing idle in 
the streets, on the tops of houses, or at windows, many of 
them only partially dressed." This occurrence u w as well 
calculated to act as the exciting cause of disease : accordingly, 
in the course of two or three succeeding days, eight or nine 
persons, immediately adjacent to where the fire had raged, 
were attacked by malignant fever." They had all "been 
more or less exposed at the fire," without having u previous- 
ly had any mutual intercourse." u The disease appeared 
suddenly, and nearly at once ; in five or six families, the in- 
dividuals of which had never exchanged a visit, or even a 
word, either business or ceremony. From this time, the 
number of sick continued daily to increase." " But this was 
not all. During the first week of September, the disease re- 
newed its attack, in all those neighbourhoods where it had 
made its appearance in preceding parts of the season. In- 



* Here Dr. Caldwell remarks, that, in the autumn of the summer in question, 
" the low grounds of most large rivers in the United States, were subject to malig- 
nant fever. Along the banks of the Susqtiehannch, the ravages of this disease 
were melancholy and unprecedented. In some instauces it hurried whote families 
to the grave." 



265 



deed, there were now scattering cases of it in most parts of 
Water Street, between Race and Almod Streets ; a distance 
of somewhat more than a mile. But the district, extending 
from Market to Walnut Street, and from the east side of 
Front Street to the river Delaware, constituted the principal 
theatre of its ravages. With such violence did it rage within 
these limits, that, on the 12th of the month, the Board of 
Health thought it right to advise the inhabitants to remove, 
and to interdict all unnecessary intercourse with the sickly 
neighbourhood." 

" Throughout the remainder of the month of September, 
and till near the close of the first week in October, the dis- 
ease continued, by feeble efforts, to advance slowly from the 
low ground of the river, towards the more elevated parts of 
the city. Except, however, in alleys, and other filthy places, 
inhabited by the poor, it did not make its way across Second 
Street, nor did it, save in a few places, advance even so far. 
It may be confidently asserted, that that portion of Philadel- 
phia, which lies to the westward of Second Street, never 
enjoyed a higher exemption from disease, than during the late 
season. As the fever receded from the low ground, and ma- 
lignant atmosphere of Water Street, it became more and 
more mild, and manageable, till its evanescent shades in 
Second Street were, in many instances, much lighter than the 
common remittent of the country. " 

" After the 10th of October, the disease was no longer 
spoken of as a thing dangerous or alarming ; and, before the 
20th, there was scarcely a case of it existing in the city." 

" As it has never been alleged by any one, that the malig- 
nant fever of last season was introduced into Philadelphia 
from the West Indies, through the channels of commerce," 
&c. those who considered it as an evil necessarily of extra- 
neous birth, looked to New York alone, as the immediate 
source of our misfortune." 

" Though facts were daily occurring to convince them, that 
the disease could not, by any mode of communication, be 



266 






transplanted from Water Street even to Third Street," (i. e; 
across two parallel streets only) " they still contended, that 
it had been conveyed from New York to this place, either by 
land, by water, or perhaps on the wings of the easterly 
wind." To shew the absurdity of this Dr. Caldwell observes, 
that this fever first " appeared in New York on the 17th, and 
in Philadelphia on 19th of July f* and that " contagion could 
not possibly be conveyed thence to Philadelphia, and there 
communicated so as to produce its effects, in the short space of 
two days;" and, moreover, that " it has been clearly proved, 
as far as a negative proposition is capable of proof, that the 
late fever of New York could not be propagated even in 
Newark, Brunswick, Amboy, nor any of the neighbouring 
towns or villages, though thousands of the citizens removed 
thither, many of them actually labouring under the disease. 
How then," says he, " could it be com eyed ten times the dis- 
tance by one person in health." Other cogent reasons are join- 
ed to these, which J omit as being superfluous. I have been 
induced to prefer this account of the Yellow Fever of 1803, 
in Philadelphia, (extracted from the New York Medical Re- 
pository, vol. 1, second Hexade, p. 143 and seq.) principally 
because the early interruption, which it received by a dimi- 
nution of the temperature of the atmosphere, rendered its pro- 
gress slower, and its extension more limited, than usual, and 
thereby afforded opportunities of distinctly observing, and 
circumstantially describing, the facts, regarding its com- 
mencement and propagation, which is often impossible, in 
more rapid, violent, and extensive epidemics. 

Next after Philadelphia, the city of New York claims our 
attention.* Many sources of marsh miasmata appear to 



* An accurate description of the local circumstances of this citr is perfixed to Dr 
Miller's report to the governor of the state, " on the malignant disease which pre- 
vailed in the city of New York in the autumn of 1805. n It is in these words, — 

•« The city of New York lies in lat. 40° 42. 8. N. and long. 74° 9. 45 W. : at the 
confluence of the River Hudson, and of Long-Island Sound, or the East River; 
and on the southern and narrow extremity of Mahattan Island, which is about fif- 



267 

have been created and annexed to this city, subsequently to 
the peace and independence of the United States, in 1783. It 
was, however, long since, and, probably, from its beginning, 
very frequently troubled with intermittent, and what were 
called bilious remittent fevers ; probably sometimes aggra- 
vated, by great summer heat, into the violence and mortality 
of Yellow Fever : though, by the want, or negligence of 
medical writers, we have no accurate account of them. It 
may, I think, be presumed, that an epidemic of this kind oc- 
curred at New York, in the months of .August and September, 
1702; mention being made of one which in those months 
(when no other fever is likely to have prevailed epidemically) 
killed about seventy persons weekly, by George Keith, in the 
account of his travels from New Hampshire to Curituck : 
(printed in London, 1706.) He had then become a clergy- 
man of the Church of England, after having been a Quaker; 
and appears to have preached on the 30th of September, at a 
fast appointed by the governor, on account of the recent 
great mortality which then amounted to 500 persons, a very 

teen miles in length, and from one to two in breadth. The site of the city, as it 
originally stood, was very irregular, belug broken into hills and declivities, and in- 
dented with small rivulets or creeks, skirted -with marsh. Many of the hills are level- 
led ; but the marshy grounds, though covered with houses and pavement, are still 
low and moist. The city is about twenty-seven miles from the ocean, and is 
washed on both sides with water of great depth, whose current is veiy rapid, 
whose tide ebbs and flows about six feet, and which is nearly as salt as that of the 
neighbouring sea. On both sides of the city considerable encroachments have been 
made on the water, by artificial ground, the whole extent of which may be 
computed at not less than 132 acres. Of this, ninety acres lie along the East River, 
and forty-two along the Hudson- The portion of it on the East River forms that 
part of the city where malignant fevers have always Jirst become epidemic, and 
chiefly prevailed* The wharves and docks are constructed of logs and loose stones. 
All the fresh water, used by the inhabitants, is procured from wells within the city, 
and is now become extremely impure. The population of New York may be 
estimated at about 76,000. 

* Dr. Miller explains this in another place, by observing, that the " made ground 
on the North, or Hudson's River, is much less extensive, and the materials com- 
posing it much less foul and corrupt, than that on the East River;" and that " the 
miasmata come to maturity on the one side, two or three weeks sooner than on 
the other." 



268 



considerable proportion of the inhabitants at that period ! ver- 
looking the intermediate space of time until 1791, we find, 
that a considerable number of cases of Yellow Fever occurred 
in the autumn of that year, in a part of Water Street* near 
Feck Slip, then noted for the filthy state of the neighbouring 
docks. Others occurred to a greater extent in 1794; but 
were confined to persons who either lived, or were commonly 
employed near the slips, wharves, and other obvious sources 
of marsh miasmata ; and this was the case in the three follow- 
ing years. In 1798, the disease prevailed more violently and 
extensively as an epidemic, and was computed by Mr. Har- 
die, in his plain and circumstantial account of it, (printed in 
8vo. at New York, 1799,) to have occasioned the deaths of 
2086 persons in that city. The committee, appointed by the 
Medical Society of the State of New York, to inquire into 
the symptoms, origin, &c. of this disease, appear, by their 
printed report, to have been convinced of its domestic origin, 
from local causes : and they declare, as the result of their 
experience, that " it is not a contagious or catching disease," 
in the popular and common acceptation of the phrase ; that it 
is not communicable from person to person," kc. See New 
York Medical Repository, vol. 3, p. 293. 

During the summer and autumn of 1800, in the neighbour- 
hood of Water Street, and of the different slips, and other 
acknowledged sources of miasmata, one hundred or more i 
of Fellow Fever occurred simultaneously and intermixed, in 
the same situations, with intermitting and bilious remitting 
fevers: of the former, more than fifty terminated fatally, in 
a few days; many of them "exhibiting the symptom 
yellow skin, black vomiting, and stools, Hemorrhages, fcc." 
On this occasion it was not pretended that any importation 
of the disease had been made, nor that it had been propagated 
by contagion, " beyond the limits of that portion of tin 
mosphere of the town, allowed by every body to have been 
contaminated by the exhalations of putrefaction ; and within 
such limits it is well known that an adequate cause is con 



269 

stantly in operation, independently of contagion.' 5 See 
New-York Medical Repository, vol. 4, p. 207-8. About twice 
as many cases of Yellow Fever occurred in the following year 
at New-York in the same months, and in nearly the same 
situations, with similar results. 

In the summer and autumn of 1803, this disease recurred 
more extensively, and with greater violence, in consequence 
of the excessive hot weather which began early in July, and, 
excepting five or six days in that month, (say Doctors Mitchell 
and Miller,) was more intensely and uniformly hot, than we 
ever remember before to have experienced in this climate, for the 
space of some time." " The first public alarm took place 
from some deaths about the CofFee-House slip, and in that 
neighbourhood, where, from the number and malignity of the 
cases, the atmosphere must have been charged with miasmata 
of great virulence." u The streets lying near the margins of 
the two rivers, and those inhabited by the poor," &c. " suf- 
fered the principal ravages of the disease." A large portion 
of the sick " consisted of instances in which one individual 
only was attacked in the midst of a family, the members of 
which assiduously attended the patient, without contracting 
the disease. Many aged, and very young persons, whose con- 
dition imposed confinement in their houses, without the occur- 
rence of any preceding case in their families, were attacked 
with the disease in its most virulent form. Multitudes, also, 
took the disease, who had not previously approached any sick 
person, any suspected vessel, or any families alleged jto be 
imbued with contagion. One person was attacked in the 
Debtor's Prison, who, for three months before, had not been 
beyond its walls, and no other person in the prison was pre- 
viously, or subsequently, affected with the disease ; many who 
fled from the city, were attacked with the disease and died, 
not only in all the surrounding country, but at Newark, 
Elizabeth town, Brunswick, &c. without communicating in- 
fection, in a single instance, to physicians, nurses, or any 
other attendants. But, they add, one of the most decisive 



270 

proofs of the non-contagiousness of Yellow Fever, is derived 
from the absence of all contagious influence from our Yellow 
Fever Hospitals.'' " These asylums are generally erected 
within two or three miles of the cities to which they belong, 
but entirely beyond the reach of an atmosphere contaminated 
by the local miasmata of the city. Neither in New-York 
nor in Philadelphia, is there a single example of a person em- 
ployed in these Yellow Fever Hospitals, being attacked by 
that disease, unless he had previously passed sometime within 
the limits of the sickly city." See New-York Medical Re- 
pository, vol. 7, p. 183-4. 

In a letter from Dr. Miller, the resident physician for the 
city of New- York, to his excellency Governor Clinton, dated 
January 6, 1804, the preceding facts are more minutely stated, 
with the others, proving, as far as the subject was susceptible 
of negative proof, that the fever in question did not arise from 
any foreign or imported contagion. Of the mortality produced 
by this fever, from its commencement, about the 20th of July, 
till its cessation, at the end of October, Dr. Miller says, " the 
number of deaths in this city amounted to 503 ; those at the 
Hospital at Bellevue, to 103, and those at the Marine Hos- 
pital, in Staten island, to 68 ; making a total of 674 : to 
which should be added an indefinite number, who fled from 
the city, and died of this disease in the neighbouring country 
and villages." See printed M documents, relating to the 
Board of Health." (New-York, 1806, 8vo.) p. 55. 

The summer of 1804 was but very moderately warm along 
the coast of America, northward of Carolina, and, as might 
be expected, the Yellow Fever did not recur at New- York, 
&c. in that year. But the summer of 1805 was. according to 
Dr. Miller's official statement,* *• remarkable for the duration, 
as well as the intensity, of heat, along the whole of our o 
(United States) ; and the consequence was, not only that 

* In his masterly report, made as resident-physician for the city of New-York, to 
the governor of the state, dated January 12, 1S06, and printed with "documents re- 
lating to the Board of Health," Svo. 



271 

nearly all the Atlantic cities were visited with pestilence, but 
that, in several of them, it made its appearance in forty-eight 
hours, or nearly of the same time, an occurrence which cannot 
he explained on the contingency of contagion." As usual, 
sporadic cases of the disease first occurred : but, at the begin- 
ning of September, these, according to Dr. Miller's official 
report, " had become so numerous as to ascertain the exist- 
ence of the epidemic ;" which, throughout September and 
October, continued to prevail with more or less severity, ac- 
cording to the fluctuating states of the weather ; but, towards 
the close of the latter month, the coldness of the season had 
evidently checked its progress, and, at the beginning of No- 
vember, the city was nearly restored to its usual health. 

From returns, authenticated by the city inspector, (Mr. 
Pintard) it appears that the number of inhabitants then 
amounted to 75,770, and that of these 26,996 retired from the 
city : and, as may be presumed, from the most unwholesome 
parts of it ; by which the number of persons attacked by the 
disease was doubtless much diminished : as it only amounted 
to 645, and that of the deaths to 302 : Of these twenty-eight 
were in the Marine Hospital, and fifty-two in that of Bellevue : 
and about forty others are supposed to have sickened and 
died in the country, after their flight. 

Dr. Miller, in his report ^o the Governor, states that, 
" during the early period of the 1 epidemic, nearly all the cases 
took place" (as formerly) " on the eastern side of the city, in 
Front, Water, and Pearl Streets, and principally below Bur- 
ling Slip :" But u afterwards became more diffused :" and, 
" about the 20th of September, began to prevail near the north 
river :"* Where, from circumstances already mentioned, he 

* Party zeal and prejudice often render men incapable of deriving any evidence or 
information from facts, but such as suit their own views and purposes. Dr. Chisholm, 
at page 205 of his letter to Dr. Haygarth, introduces one to himself, from Dr. Hosack, 
dated New-York, July 9th, 1808, in which there is an abundant display of zeal, I do 
not say for maintaining the cause of truth, but for asserting the supposed contagion and 
importation of Yellow Fever: He also communicates his intention to -write and print 



272 

supposes that " the miasmata come to maturity" later than 
on the east side. He adds, " on the whole, the low grounds, 
on the margins of the two rivers, certainly produced a chief 
part of the cases." P. 46. 

a letter, charging Dr. Miller with " want of candour," in his official report to the go- 
vernor; which charge he founds upon the following statement, viz. 

"As a member of the Board of Health, he (Dr. Miller) must have known that the 
disease was confined for many weeks to a small portion of the eastern side of the city, 
and that, not a case occurred in any other part of the town, that was not referable to 
that, as its source. Such was the statement of the Board of Health, to our citizens, 
and, in consequence of which, they forbade intercourse with the infected portion of our 
city, and ordered an abandonment of that part of the town, &c." 

He adds, "a few weeks after, the infection extended a few streets further. The 
Board of Health accurately denned its limits, and again declared, that still not 
occurred but could be traced to this spot of the city, as its source. Dr. Millet 
fully enumerates the cases occurring, and the numerous parts of the city in which the 
sick reside, but as carefully suppresses the observation of the Board, of which, too, he 
was a member, and must have known, that the persons so taken sick, had, prior to 
their attack, been exposed to the infection by frequenting the infected spot" How 
strangely Dr. Hosack here mistakes the obvious import or evidence of an important 
fact ? One of the strongest proofs of the local origin of Yellow Fever, results from the 
circumstance of its beginning, and remaining, almost exclusively, in particular spots 
or situations. Of this, Dr. Miller was very sensible ; and, if he omitted to state " the 
observation of the Board," respecting it, he could only have done so because it appear- 
ed superfluous, after he had so distinctly mentioned the facts to which it related. And 
is it, then, possible, that Drs. Hosack and Chisholm can have been so inept as to believe 
that these facts could operate in supporting their opinion of the importation and conta- 
gious nature of this disease ? Do they conceive, that if it were contagious, it would have 
been so many weeks confined to one spot, and that, when it afterwards " extended a 
fell streets further," those only would have been attacked by it, who had visited that 
identical spot P This is exactly what would happen in regard to a disease not contagious, 
but arising from miasmata ; because, the soil in which they are produced being inomava- 
ble, and its exhalations incapable of causing disease, at any considerable distance from 
their source, persons to be acted upon by them must necessarily approach that source. 
But contagion having no such immoveable origin will not be thus confined ; persons in- 
fected by it, and sickening in different places, naturally infect others, who soon spread 
the disease widely, so that the spot where it first appeared often becomes less dange- 
rous than most others, and its atmosphere does not continue to produce disease, when 
the sick have been removed, and the houses shut up, as happens in cases of yellow fe- 
ver. With the same fatuity, Dr. Chisholm, in his Utter to Dr. Haygarth, has pub- 
lished one from Dr. A. Fothergill, late of Bath, who. writing to the American consul, 
at Bristol, of the Yellow Fever at Philadelphia, in 1805, and mentioning that it had, in 
November, received a check, apparently from the cook 
remained for some weeks a local disease in the southern suburbs," (adjacent to the 



273 

Dr. Miller adds, at p. 53, " It appears, from the records 
of this epidemic, that there were thirty-one streets of the city,, 
most of which continued to he crowded with inhabitants, in 
which only a single case occurred in each ; and, in the mass of 
six hundred cases, reported to the Board of Health, there 
were only thirty -Jive houses in which more than a single case 
was found." " The great mass of persons attacked with the 
disease, consisted of such as never had approached the sick, 
or any other assignable source of contagion ; and, on the con- 
trary, as will presently appear, great numbers were exposed 
to close intercourse with the sick, without injury." 

Further, in regard to this epidemic, the health officer, Dr. 
Rodgers, made a long, minute, and satisfactory report to the 
Board of Health, (dated December 19th, 1805) of every ves- 
sel, and of every circumstance, connected with the possibility 
of an importation of the disease, which is concluded in these 
words. " I have now clearly shewn, as far as negative proof 
can go, that whatever might have been the cause of the late 
epidemic, it did not arise from any neglect of duty at the qua- 
rantine ground, nor did it come through that channel. 99 * Pre- 



mar shy low grounds, at the confluence of the Delaware and Schuylkill) "b:it, at length 
was communicated to several of the principal streets in the city, as far as Eighth street, 
westward," (persons who had been exposed to miasmata in other places, happening to 
fall sick in these) "but it chiefly infested Water street, Front street," (running paral- 
lel with, and next to Water street) "and the margin of the Delaware." He adds, 
" many of the professors and medical practitioners here, deny that the disease is conta- 
gious, and in this notion the body of merchants bear them out." Dr. Fothergill, how- 
ever, adheres to the old notion of contagion and importation, and no wonder that it 
should have adherents, in men who fancy they can see evidence of a contagious quality, 
in facts which decidedly prove the contrary, to all who are able to reason with impar- 
tiality. 

In the letter first mentioned, Dr. I losack invited Dr. Chisholm to " visit the United 
States," adding, "you would find materials for giving a final blow to your enemies: 
three or four months residence here would be sufficient." Was this a sincere effusion 
of intolerant zeal, or did Dr. Hosack intend that his invitation should reach Dr. Chis- 
holm on the first of April ? 

* One motive for this report appears to have been, that " attempts had, as is stated 
by Dr. Rodgers, (p. 19) been made by some, to prejudice the public mind against him, 
because he," (who had had the best opportunities of observing and judging of the facts) 

35 



274 

vious to this conclusion, the health officer had given an ac- 
count, in detail, of all the early cases of Yellow Fever, which 
came under his notice, in order that the board might judge 
whether the disease went from the quarantine ground to New 
York, or came from the city," to the Marine Hospital. Of 
these cases a great proportion occurred in u a particular 
neighbourhood in Water Street; which neighbourhood did not 
exceed two hundred yards from one extremity to the other." 
" The circumstance (says he) of so many sickening in one 
house, and within so narrow a compass, in Water Street, and 
the disease having appeared in a former yQ&r first in that very 
neighbourhood, and in every year of pestilence, always first 
shewing itself in situations precisely similar, establish the po- 
sition of a domestic origin, Nor can it be pretended, (he adds) 



" believed in other causes of disease than importation." These "attempts" seem to 
have been connected with a newspaper attack, (which I have not seen) made by Dr. 
Hosack, of New-York, on Dr. Rodgers, in the preceding month, when the latter had 
shown some unwillingness to allow the former, accompanied by two other persons, to 
inspect the JWarine Hospital, without some pledge on their parts, to secure himself 
against a repetition of the ill-treatment or misrepresentation which he complained of 
having lately suffered. Dr. Chisholm, in his letter to Dr. Haygarth, (pages 72 and 73) 
avails himself of this transaction to charge Dr. Rodgers with having "made a most sin- 
gular and unexpected attempt to exact from these gentlemen a preliminary stipulation 
of concealment,-" and appears to attribute it to guilty apprehensions in Dr. Rodgers; 
asking, " why have recourse to arts so unbecoming; were there not sinister objects to 
be obtained?'' Knowing nothing of this transaction but the litUe which Dr. Chis- 
holm has stated, I am but ill qualified to answer his questiou. I can, however, easily 
conceive, that, as Dr. Hosack had been long known to be a very zealous advocate for 
the supposed contagion and importation of yellow fever, Dr. Rodgers might well suv 
pect, what seems to be true, that the former had come to inspect the Marine Hospital, 
and quarantine ground, in the hope of discovering something to enable the believers in 
importation to obviate the triumph of their opponents, or, at least, make it a matter of 
doubt, whether the disease of that season had not arisen from imported contagiou ; and, 
as this would, of necessity, imply negligence on the part of Dr. Rodgers, and as he 
could not well expect candour and fairness from one so much prejudiced, and acting 
from the motives just mentioned, it seems to me that Dr. Rodgers might, very ho- 
nestly, have wished to secure himself from misrepresentation, and that it would have 
better become Dr. Chisholm had lie been less eager in attributing bad motives to Dr. 
Rodgers, especially as it appeai s, that after Dr. Hosack and his friends had seen all the) 
wished to see, they could find no subject of complaint, except Dr. RodgerVs backward 
ness in gratuying their curiosity. 



275 

that the communication between quarantine ground could pro- 
duce it here, because this was exactly the place where, of all 
others, the communication was least : nay, there could be 
none at all, for there were no stores," &c. " nor had any of 
these thirty-five patients been at the quarantines, at any time 
of the summer previous to their admission, nor had any of 
then any connexion with infected ships or diseased per- 
sons." 

In order to bring this view to a conclusion, I have only to 
notice, in a few words, the occurrence of Yellow Fever at 
New London, in Connecticut. At Providence, in Rhode 
Island, and at Boston, in Massachusetts Bay. At the for- 
mer of these towns, this disease appeared as an epidemic I 
believe for the first, and only time, in the months of August, 
September, and October, 1798, in which the summer was in- 
tensely hot and dry, beyond all example ; the thermometer 
having been, for several days, in succession, at from 95° to 
97". The disease first appeared about the 26th of August, 
and terminated in October. " The whole number of persons, 
whose complaints clearly indicated the pestilence, or, as it is 
called, the Yellow Fever, did not exceed 246 ;" and, " of the 
above number, 231 cases were clearly traced to the spot where 
the sickness commenced ; that is, the patients were conver- 
sant, or had been in that part of the city, a few days, before 
they were seized. The part in which the septic gas appears 
to have been so highly concentrated, extended sixty rods 
north and south," (along the harbour) " and about twenty 
rods west, being bounded easterly on the harbour" This cir- 
cumstance clearly manifests the connexion of the disease with 
miasmata, proceeding from the grounds, wharves, &c. imme- 
diately adjoining the water ; though the respectable clergy- 
man, by whom (with the approbation of several other gentle- 
men members of the committee of health, &c.) the account on 
which I principally rely, was drawn up, appears to ascribe 
the disease chiefly to exhalations from a quantity of salted 
fish then beginning to putrefy, within the space where the 



276 



disease began. He adds, " we have not even a shadow of 
ground to suppose the disorder was not of domestic origin." 
Dr. Coit, a physician of New London, in a letter to Dr. 
Mitchell, states, that the persons first attacked, (and to whom 
he was called) were an innkeeper, with his wife, son, and 
daughter, living in a street next and close to the Water, 
(Bank Street) and that within a very few days he was called 
to eleven other patients in the same street, and all within 
eight rods of the innkeeper's House. Eighty-one persons died 
in all. There was no appearance or suspicion of contagion 
from the sick. See New York Medical Repository, vol. 2. p. 
304-5, and 372 to 378 ; also vol. 3, p. 229. 

At Providence, the Yellow Fever became prevalent in 1797 ; 
also in 1800, and again in 1805. u It has uniformly made its 
appearance, and committed its principal ravages, in the south 
part of Water Street, or the lanes and alleys immediately ad- 
jacent; and those solitary cases, which have occurred else- 
where, could, with very few exceptions, be traced to this de- 
voted spot." "The portion of Water Street which has been 
thus repeatedly the seat of Fellow Fever, is less than a hundred 
rods in length. It has, in this place, a south-east direction. 
The houses on the water side are built, as near as possible, 
to the natural bank of the river. The wharves, of course, 
which are extended in rear of them, westward to the channel, 
arc artificially raised, partly filled with earth, and partly con- 
structed with logs, covered with oyster-shells and earth, 
leaving vacuities beneath, &c." " The south-end of the 
street is bounded by a small cove, or inlet from the river, 
which receives, through a swale, or ravine, (before noticed) 
the wash of an extensive range of meadows f which, fer- 
menting in hot weather, afford unwholesome exhalations. 
To these and other local circumstances, described by Dr. 
Wheaton, (in his " Brief Account of the Yellow Fever, which 
has appeared, at different times, in Providence,*' he add*, 
that the spot just mentioned is " confined by hills eastward 
and westward;" and that, by »< presenting a south-wo 



277 



slope to the water, it gives to the mid-day, and afternoon sun, 
an almost vertical power." 

Dr. Wheaton informs us, that the summer of 1797 had 
hcen remarkable for a long continued drought ; but, about the 
1st of August, there ensued " abundant rains," which " were 
succeeded by an intensely Iiot sun ; the thermometer, in an air> 
situation ranging from 86" to 91'." " The Yellow Fever made 
its first decided appearance on the 13th of August," and 
" continued to rage to the 30th of September, in which time 
it attacked 102 persons, of whom forty-five died. Its early 
disappearance was ascribed to the almost universal desertion 
of that part of the town, and to a " very heavy rain and 
tornado," which occurred on the 8th of October. 

w In 1800, the first case of Yellow Fever occurred on 
the 15th of August, and the disease continued to prevail until 
the 5th of October." " There were, this year, eighty-three 
reported cases of Yellow Fever, of which fifty proved fatal." 
The sickly district was more " universally deserted than in 
the preceding year ; a circumstance which may account for 
its early disappearance, as the other parts of the towns were 
uncommonly healthy." 

" In 1805, the disease made its appearance as early as the 
25th of July, after a very unusual duration of Iiot and dry 
weather. As the town council directed an immediate and 
complete evacuation of this part of the town, it soon subsided, 
and, on the 10th of August, had disappeared. The people, 
however, being impatient to return to their habitations, se- 
veral new cases occurred in September." " Here, as else- 
where," (adds Dr. Wheaton) the Yellow Fever " has not 
been propagated by the sick in situations otherwise healthy ; 
or, in other words, has not been found contagious. Of a great 
number removed to the Hospital, in an airy situation, south- 
west of the town, there has been no instance of the disease 
being taken by the attendant physicians or nurses. See New- 
York Medical Repository, vol. 10, p. 329 to 337. 

At Boston, during the prevalence of very warm weather, in 



278 



the month of August, 1796, and " at the south-east part of 
the town, near a considerable extent of flats, which were 
daily exposed, for some hours, to the action of the sun, a fever 
began, and spread thence to the neighbourhood of some of the 
docks, proving fatal to about thirty persons. Dr. Warren, 
an eminent physician there, in a Letter to the American 
Academy of Arts and Sciences, then declared tliat he had, 
almost every autumn, seen at Boston a considerable number 
of similar cases, " not excepting the black vomit, nor the ycl** 
low skin ;" and that it was, " what is pi-operly termed, a 
bilious remittent fever." 

" In the year 1798 this fever recurred in a very aggravated 
form, during the prevalence of extremely hot weather, when 
the thermometer was often above 90 , and sometimes at 96% 
of Fahrenheit's scale. It attacked only those who lived, or 
passed sometime in the vicinity of a mill-pond, drained of its 
water, so as to leave the mud, and other impurities, exposed 
to the sun's rays : and in the vicinity of several large dc cksj 
into which large quantities of refused vegetable and animal 
matters were conveyed from the market. 

According to Dr. Brown, u not one of twenty, and upward*., 
who first took the disease, recovered:'* and. in all. about three 
hundred died of it. u The fever prevailed with much malig- 
nity, till about the middle of October, when it was completely 
checked by an inundating storm, from the north-east, of three 
days' continuance :" He adds, from the latter part of July, 
to the middle of September, f* the weather was. perhaps, 
never known so uniformly and excessively hot and debilitating." 
It is asserted also, u that the fever did not seem to be con- 
tagious :" that there was '« no instance of its being commu- 
nicated to the nurses or attendants of the sick, in places whei? 
the disease was not originally contracted/' See New -York 
Medical Repository, vol. 2. p. 360 to 363. 

This fever appeared again at Boston, in August. 1808, and 
prevailed until the month of October, (in the same ports of the 
town as before,) " and with greater malignity than in any 



279 

former year, equalling the worst species of genuine plague ; 
yet the range of the disease was quite limited." " It com- 
menced in debility, which increased with the progress of the 
disease, till it terminated in death, more commonly on the 
third day, seldom so late as the fifth : indeed, the patient 
might be said to be dying from the moment of seizure. The 
venous congestion was very apparent from the bloody 
suffusion of the eye ; from the cadaverous appearance of 
the countenance, and from the livid tinge of the whole 
surface of the body and limbs ; the cuticular vessels, and 
those of the adipose membrane, being loaded with putrid 
blood." The disease was " wliolly confined to houses promis- 
cuously situated at the heads of wharfs', in the south part of 
the town ; and it was remarkable, that if a patient, under the 
disease, was carried out of the range of the morbid atmos- 
phere, into a healthy part of the town, and attended by per- 
sons there resident, the disease was not communicated in a 
single instance : but not so if lie remained on the spot where 
he took the disease." New- York Medical Repository, vol. 
vi. pages 338 and 9. 

I do not find that the disease was even suspected to have 
arisen from any importation of contagion. 

Those of my readers who, by a love of truth, may have 
been induced to follow me attentively, in the view which I 
have now taken of the Yellow Fever, in different parts of 
America, and whose minds are unbiassed, will, I am confi- 
dent, clearly recognize in that disease all the peculiar features, 
and characteiistic marks by which marsh fevers are distin- 
guished in all parts of the world. And they will naturally 
conclude that, though it be the most aggravated and violent 
of the fevers arising from miasmata, this aggravation and 
violence are produced only by a greater concentration or viru- 
lence in the latter, joined to a greater intensity of atmosphe- 
rical heat, acting on persons, but little accustomed to bear it, 
whilst they retained the excitability of cold or temperate cli- 
mates, together with an habitual disposition to generate that 



280 

portion of animal heat which such climates require. They 
will have seen that the yellow, like other marsh fevers, is 
always exasperated by great heat, and extinguished or great- 
ly mitigated by cold ; that, between the tropics, it prevails 
simultaneously with the milder forms of marsh fevers, violently 
attacking strangers from cold climates, whilst the natives or 
long residents are at most only subject to intermittents or 
mild remittents :' they will have also seen, that in temperate 
situations, this disease in the early part of the summer, be- 
fore the atmosphere has become intensely hot, is commonly 
preceded by, or rather shews itself in, the forms of intermit- 
ting or remitting fever; and that when being exasperated by 
excess of heat, it lias assumed, and for some time prevailed 
under, the appearance of an epidemic Yellow Fever, the ac- 
cession of cool weather speedily reduces it again to its milder 
forms ,• and that a freezing temperature soon puts an end to 
its appearance, even in those forms, as it commonly does to 
other fevers occasioned by exhalations from marshes, and to 
no others : And they will also have seen, that the common 
hilious remittent, of hot climates, which is universally ad- 
mitted to be the effect of miasmata, differs from the Yellow 
Fever, only by being a little less violent : that, at the 
utmost, their symptoms vary only in degree ; and that, in 
truth, even this difference is often so imperceptible, that 
the College of Physicians of Philadelphia, when anxious 
to assign a distinction between the yellow, and the bilious 
remittent fevers, thought it necessary to allege one which 
is not only invisible, but without existence (i. e. contagion.*) 



It has commonly happened in places liable to yellow fever, when the cause of that 
(miasmata) exists, without being sufficiently powerful and abundant to create an 
epidemic, that a few cases of yellow fever occur, iuterniixed with what are called bilious 
remittents and intermittents, all from the same cause, and sometimes even in the same 
families. In other seasons, when the miasmata are sufficiently abundant and powerful 
to produce an epidemic yellow fever, the first cases of it are often accompanied by, and 
scattered among, remittents and intermittents ; and if, as happened at New Yoi-k, in 
1805, some of the physicians should believe that yellow fever can only be produced by 
an imported contagion, and no vessel should have arrived from the West Indies, so as 



2SI 

In fact, there is no difference between these fevers, except- 
ing the greater violence, and consequently greater danger, 
attending the former, than the latter ; for the Yellow colour 
appears in both, and, supposing the fatal black vomit, with 
profuse hemorrhages and petechia, to occur only in what is 
called Fellow Fever, (though they are sometimes seen in fevers 
known and admitted to arise solely from marsh effluvia) they 
cannot be included among its essential or distinguishing 
symptoms, unless death be also considered as essential to the 
disease.* Nor can any exasperation of symptoms, which 
has been preceded by a great increase of heat, give any rea- 
son to suspect that a fever, whose symptoms are thus exas- 
perated, did not originate from miasmata ; because such an 
eaxsperation is invariably produced by that cause, in marsh 
fevers ; and by it they are susceptible of the most dangerous 
and malignant appearances. Of this Sir John Pringle was 
fully convinced, when, at p. 324, of his work on the Diseases 
of the Army, he made this observation, viz. 

u I shall observe, upon the whole, that the autumnal re- 
mitting and intermitting fevers, of low and wet countries, 
when at the worst, may be considered as another species of 
pestilence, since they have been seen with all the virulent symp- 
toms peculiar to that class of diseases." 

As a farther proof of the identity of Yellow and marsh 
fevers, I shall remark that, besides their simultaneous concur- 
to be chargeable with such importation, these physicians have commonly thought it pro- 
per to declare, that these cases were not the yellow, but the common indigenous, bilious 
fever ; and thus they have, as is asserted, sometimes hindered the inhabitants from leav- 
ing a noxious situation until it was too late. 

* Dr. Lind, at p. 118, of his Essay on the Diseases of Hot Climates, (5th edit.) treat- 
ing of the yellow fever, says, "having considered this disease with attention, I am now 
of opinion, that the remarkable dissolution of the blood, the violent hemorrhages, the 
black vomit, and the other symptoms which characterize the yellow fever, are only 
accidental appearances, in the common fever of the West Indies. They are to be es- 
teemed merely as adventitious in the same manner as purple spots, and bloody urine, 
are in the small-pox, or as an hiccup in the dysentery ; like these they only appear 
when the disease is accompanied with an high degree of malignity, and, therefore, al- 
ways indicate great danger." 

36 



282 

rente, and mutual interchanges, as before-mentioned, they are 
not unfrequently converted one into the other, in the very same 
individual. Of this there are many instances and proofs, 
some of which having been already noticed, I need only ad- 
duce the following extract, from Dr. Rush's Letter to Dr. 
Miller, dated October 8th, 1802, concerning the Yellow 
Fever which then prevailed at Philadelphia, and with more 
than common mortality, at least, in proportion to the numbers 
of sick. " Never (says Dr. Rush) has the unity of our au- 
tumnal fever been more clearly demonstrated, than in our 
present epidemic. Its four principal grades, viz. the inter- 
mittent, the mild remittent, the inflammatory bilious fever, 
and the malignant Yellow Fever, liave all run into each other in 
many instances. A tertian has ended in death, with a black 
vomiting; and a fever, with the face and eyes suffused with 
blood, has ended in a quotidian, which has yielded to a few 
doses of bark. The Fever, in Baltimore, I have been in- 
formed, has put on the same multiform appearances and 
changes." See New York Medical Repository, vol. vi. p. 
249. Greater proofs of near affinity than these can hardly be 
desired.* 



* The convertibility of yellow and marsh fevers into each other, was attested, almost 
half a century since, by the late Dr. Huck Saunders, who had become well acquainted 
with them, as an army physician in the West Indies and North America. " It some- 
times (says he) depends upon the manner in which a patient is treated in the begin- 
ning, whether he shall have a jellow, or only a remitting or intermitting fever." See 
Pringle's Diseases of the Army, p 108. 

Dr. Rush, and his associates, who were incorporated as the Academy of Medicine, of 
Philadelphia, in their letter to the Governor, December 1st, 1797, say, " by depleting 
remedies, the most malignant yellow lever may be changed into a common bilious fe- 
ver ; and, by tonic remedies, improperly applied, the common bilious may be made to 
assume the symptoms of the most malignant yellow fever " Dr Drysdale, writing of 
the yellow fever at Baltimore, in 1794, observes, that this fever, in its favourable issue, 
would sometimes terminate in a tedious quotidian, or tertian ague." See Cox's Medi- 
cal Museum, vol i. p. 41. 

Dr Gillespie, also, in his "Observations, kc." already quoted, after mentioning the 
epidemic fever, which had proved fatal to at least one half of the crews of the Spanish 
squadron, captured by Admiral Harvey, at Trinidada, in February, 1797, adds, that 
from " the accounts which our medical gentlemen collected at Trinidada," this epi- 



28S 

Finally, the Yellow and marsh Fevers resemble each other 
by attacking the same organs or parts of the body, especially 
the stomach and smaller intestines, which were found to be 
inflamed in remittent fever, even at Copenhagen: and they 
also lay the foundations of similar chronical affections. 

With so many proofs of identity in their cause, and of the 
nearest affinity in their symptoms, and reciprocal conver- 
sions into each other, as well as in their effects on the human 
body, and their changes by heat and cold, &c. it would be 
highly unreasonable not to consider them as being only varie- 
ties of one disease. And I think with Dr. Rush, that we 
might as well "distinguish the rain which falls in gentle 
showers, in Great Britain, from that which is poured in torrents 
from the clouds in the West Indies, by different names and 
qualities, as impose specific names and characters upon the 
different states of bilious (or marsh) fever." See Medical 
Inquiries, &c. vol. 4, p. 45. 

Among the points in which the yellow, resembles other 
marsh fevers, (and which, therefore, co-operate in proving 
their identity) I might have included that of its possessing no 
contagions property : for certainly this fact has been attested 
and demonstrated in so many places, and by so many unques- 
tionable authorities, that no unprejudiced reader, who shall 
have bestowed proper attention upon the proofs and occur- 
rences which have been stated in the preceding pages, can en- 
tertain the smallest doubt respecting it. Wishing, however, 
not merely to convince the unprejudiced, but to reclaim and 
undeceive those of an opposite description, so as to obviate all 
future disagreement on this important question, I shall here 
introduce a few additional facts, testimonies, and arguments, 
respecting it. 

demic appears to have been " an ardent Yellow Fever, terminating' in remittent and 
intermittent fevers, in a manner similar to -what happened here, (i. e at Martinico) in 
1796," as mentioned by him, at pages 130, 1, and 2 ; and also at page 164, 5. I could 
easily fill many pages with similar facts and authorities; 



284 



One fact, which decidedly proves the Yellow Fever to be 
destitute of any contagious power, is that of its never having 
been communicated to others by any one of the many thou- 
sands who, in the West Indies, as well as at Charleston, 
Norfolk, Baltimore, Philadelphia, New York, &c. were re- 
moved beyond the reach of marsh miasmata, whilst labouring 
under the disease, or after having imbibed its poison ; though, 
in many of these, the disease appeared in its worst forms, and 
proved mortal. That this has been the case in all these 
places, will have been seen in the view which was lately 
taken of this subject. Of the importance, as well as of the 
certainty of this fact, the late Dr. John Hunter was justly 
convinced. " What may be considered (says he) as an eocpt- 
nmentum crucis, to prove the non-existence of contagion is, 
when the sick leave their usual residence, and go to other 
places which are healthy, without spreading the disease. 
This (he adds) constantly happens in the remittent fevers of the 
Wast Indies," (among which he includes the Yellow Fever.) 
See Diseases of the Army in Jamaica, p. 322. 

Dr. Miller, in his report to the governor of New York, has 
made a similar statement, in these words : " Many who had 
contracted the disease in New York, died of it at Boston, 
Albany, and other cities at a distance ; many, likewise, at 
Greenwich, Brooklyn, and other villages, in the neighbour- 
hood. In no instance did these victims of the epidemic com- 
municate contagion." 

To invalidate this statement, Dr. Chisholm, at p. 177 and 
178, of his Letter to Dr. Haygarth, refers to another, said to 
have been made by Dr. Wistar, respecting a case of Yellow 
Fever, at Germantown, in the year 1798, when " one person, 
who had been in Philadelphia" four days, and in a sickly 
neighbourhood, returned home, on the 7th of August, and, on 
the 9th, was attacked with Yellow Fever, which terminated 
fatally in four days.'* " Ten cases," says Dr. Chisholm, 
" are specified of the disease excited by contagion emanating* 
from the body of this person." To specify such cases is not 



295 

difficult for one who acts under the influence of party zeal ; 
nut this is not proving their existence. We are told, indeed, 
that in most of the cases the disease appeared to have been 
contracted at the house of a Mrs. Johnson ; that " one per* 
son received the infection from sorting the clothes of her 
deceased daughter, and another from the bed on which his 
mistress died," and these pretended circumstances, the only ones 
of which any mention is made, are to serve as proofs, suffi- 
cient to overturn the evidence of, probably, fifty thousand 
cases, in which this disease has manifested that it possessed no 
contagious quality. Persons who believed that nothing could 
produce the Yellow Fever except contagion, might conclude 
that it had been produced in ten persons, from one who had 
been at Philadelphia ; for they would naturally neglect to in- 
quire whether these persons had not also been there, or to 
some other source of marsh miasmata, which is a million of 
times more probable than that nature should depart from her 
constant uniformity, and render the same disease contagious 
in one instance, and not contagious in 50,000 others. Rely- 
ing on this undeniable and fundamental truth, I should think 
it a waste of my own, and of my readers' time, were I to em- 
ploy it in a further investigation of the cases in question, 
given, as they are, without any proof, or even any circum- 
stance, but those just mentioned, and which are suited only to 
vulgar apprehensions. If such cases had really occurred, and 
with such evidence as to render them credible, Dr. Rush, who 
must have heard of them, and who, at that time, believed that 
the disease might sometimes be contagious, would, probably, 
have been so far confirmed in that belief, as to have abstained 
from the public retraction, which he afterwards made of it ; 
and he certainly would not, in the very letter containing that 
retraction, have declared, as he did, that the Yellow Fever 
" lias uniformly perished in the high and healthy village of 
Germantown, when carried from Philadelphia." See Medi- 
cal Repository, vol. 6, p. 165. 



286 

The impossibility of spreading the disease in situations re- 
mote from marsh miasmata has been attested, not merely by 
persons who believed it not to be contagious, but by one of 
the strongest assertors of the contrary opinion, by the very 
person who appears to have first misled Dr. Rush, and others 
on this subject, (I mean Dr. Lining, of Charleston} more 
than half a century ago. His words arc these, " although 
the infection was spread with celerity through the town, yet, 
if any from the country received it in town, and sickened on 
their return home, the infection spread no farther, not even so 
much as to one in the same house." See Dr. Lining's Letter 
in the Edinburgh Physical Essays, vol. 2, p. 373. This ad- 
mission, of a truth, of the most decisive import, from Dr. 
Lining, ought to have opened the eyes of Dr. Haygarth, or, 
at least, to have moderated that overbearing confidence which 
he has repeatedly manifested in his belief of the contagious 
nature of the Yellow Fever. That he was sensible of the 
weight of this admission, and of the evidence afforded by it. 
I am forced to conclude, from the circumstance of his having 
very unfairly excluded, and, to the utmost of his power, sup- 
pressed it, when he thought proper to fill the two fii-st pages 
of the appendix to his Letter to Dr. Percival, with other 
parts of the same Letter, (from Dr. Lining) in order to per- 
suade his readers that Yellow Fever was contagious. 

What Dr. Lining thus admitted, and Dr. Haygarth sup- 
pressed, was found true even in regard to the fever which 
Dr. Chisholm supposes to have been imported to Grenada, by 
the Hankey. For persons who took that disease from the 
atmosphere at St. George's, and sickened in the country, did 
not, as I am well informed, communicate the disease to any 
person there, and of this Dr. Chisholm cannot. I think, have 
been ignorant. This was also the fact at Dominica, where, 
according to Dr. Chisholm, this malignant pestilential fever 
was transplanted, and prevailed in 1793, 4, and 5. Dr. James 
Clark, (a writer of unquestionable veracity states, at p. 64. ot 
his Treatise, that — " when patients, labouring under this fever. 



287 

were removed to high situations, for the sake of breathing a 
cooler and purer air, and who, notwithstanding, fell victims to 
it, the people about them were never infected, nor did the disease 
ever prevail afterwards in such places." — But I will not abuse 
the patience of my readers by adducing further evidence on 
this point. 

Another, and, if possible, a stronger proof, of the non-ex- 
istence of contagion in Yellow Fever, is derived from the 
Hospitals. If a disease be supposed to possess any contagious 
power, however small, there is no way in which that power 
can be so readily concentrated, and rendered manifest, as by 
collecting great numbers of persons, ill of that disease, within 
the wards of an Hospital. And it is in those which have 
been exclusively appropriated for cases of Yellow Fever, at 
New- York, Philadelphia, &c. that we ought to find the most 
striking and irresistible evidence of its contagious quality, 
if it does really possess any. But the evidence which they 
have afforded is of a very different import. And here I will re- 
cur to Dr. Miller's (before-mentioned) report to the governor 
of New- York, against which Dr. Hosack, with all his eager- 
ness to object, could find no objection but the omission of one 
unimportant observation, favourable to Dr. Miller, and un- 
favourable to his opponents. Dr. Miller's w r ords are, — " no 
communication of the disease was ever observed in Yellow 
Fever Hospitals, situated at a small distance from the cities 
to which they belong. JVo exception to this has ever occurred 
in any of the numerous seasons of this pestilence at our Hospital 
at Bellevue, the Marine Hospital at Staten Island, that of Phila- 
delphia, or any other in the United States ; provided the ma- 
lignant air of the city had been avoided.* The force of this 

* Dr. Chisholm attempts, at page 174 of his letter to Dr. Haygarth, to pervert the 
plain meaning of Dr. Miller's proviso, that " the malignant air of the city had been 
avoided." "Then (says Dr. Chisholm) this malignant air could be diffused to distant 
and scattered points, and yet could not extend itself to Hospitals at a small distance 
from its origin." But the Hospitals were not at a small distance from its origin, nor 
had Dr Miller said or admitted that this malignant air could diffuse itself to distant 
and scattered points;— for, though persons occasionally sickened at such points, the 



2SS 

fact seems never to have been duly considered or appreciated* 
The numerous retinue of medical attendants, nurses, washer- 
women, servants, &c. which belong to an Hospital, must be 
known to every body. How greatly they are all exposed 
to contagion, if it could be supposed to exist in this case, 
is equally known. The most malignant degrees of the dis- 
ease are constantly found in these institutions. The expo- 
sure of the physicians, and their attendants, is well under- 
stood. The duty of the nurses leads to an incessant, and 
unreserved, intercourse with the sick," &c. &c. yet, not only 
all these have invariably escaped the disease, but likewise all 
the persons occupied in the removal of the sick, from the city 
to the Hospital, who, in this service, went, without reserve, 
into the most pestilential quarters of the town, entered the 
most filthy apartments, &C."* 

The facts, here stated by Dr. Miller, are of such notoriety 
that no farther proof of them can be necessary ; especially as 
my readers will have seen the like testimony given by others 
in the view lately taken of this disease ; I find, indeed, that in 
taking it I overlooked a Letter from Dr. Ramsay, published 
in the Medical Repository, vol. 4, at p. 220, and dated 



miasmata might have been exhaled from particular unwholesome spots, very near to 
them, and when this was not the case, the persons in question, without waiting for the 
miasmata to reaeh them ; might have gone to the places where they were produced, 
as was undoubtedly the fact. Dr. Chisholra tells us, that he has inquired, at p. 274 and 
288, of vol. i, of his Essay, "how far the influence of marsh miasms extend," and this, 
by reference to the pages in question, appears in his opinion to be tivo miles ; and he 
thence concludes, that if these miasms existed in Philadelphia or New-York, they 
u would certainly affect the adjoining Hospitals." How little he knew, and how much 
he was mistaken, on this subjeet, must have been manifested by the facts already stated, 
at p. 162, 3, and at p. 164, 5, and 6, of this volume. 

* Dr. Miller, in a note, explains the escape of these persons, by stating, ■ that they 
all resided, during the season, at the alms-house, in an elevated and healthy part of the 
city ; and, consequently, were only, for a short period, at any one time, immersed in 
the noxious atmosphere " But their communication with the sick lasted for a longer 
time, and was such as must have propagated the disease, bad it been contagious. Dr. 
Miller adds, in another note, that several persons died of the yellow fever in the alms- 
house, in 1798, and that, <* although the house then contained about eight hundred per- 
sons, no communication of contagion took place." 



289 

Charleston, November, 18, 1800, in which he writes, w that 
of forty-one cases of Yellow Fever, which" (in the preceding 
months) " took place in the Marine Hospital, forty were 
brought there from the shipping in the harbour, with the dis- 
order on them, and, in many cases, far advanced. Only one 
case originated in the Hospital, and that was of an ol&intem- 
perate man. While so many patients were dying of the Yel- 
low Fever in the Hospital, there was always a considerable 
number of other patients under the same roof, who all, with 
this one exception," (originating probably in drunkenness) 
" escaped it. This is the more remarkable, as the greatest 
number of them, as well as several of the nurses, were stran- 
gers, and affords additional evidence, that the disease was not 
contagious." He mentions, that the Hospital is half a mile 
out of Charleston.* 

Of the non-existence of contagion in Yellow Fever, Dr. 
George Fordyce seems to have been convinced, near the close 
of his life, though in opposition to all that he had formerly 
believed and taught on the subject ; for, in his fourth Disser- 
tation on Fever, the last which was published previous to his 
death, he states, as the result of all his inquiries, and of the 
best information which he had been able to obtain by convers- 
ing with, and cross-examining, individuals, who had had op- 
portunities of observing the semitertian fever of hot climates, 
(for, so he called the Yellow Fever) in those towns where it 

# My readers scarcely need be reminded of the facts which I have mentioned at 
p. 182 — 3, on the authority of Dr. John rfume, Dr. John Hunter, Dr. Walker, &c. of . 
the absence of contagion in the different hospitals at Jamaica, notwithstanding the 
many thousands of patients with yellow fever, admitted into them at different times. 
Nor of the opinions of the medical officers of the army under sir ttalph Abercrombie, 
on this subject. I can safely aver, that several thousand cases of this disease fell under 
my own observation in the West Indies, and that I did not find the least appearance of 
a contagious quality in any of them. The fevers of the Ea6t Indies, though so ex- 
tremely violent as sometimes to produce death in a few hours, are equally destitute of 
contagion. Dr. Wade, on the diseases of seamen and soldiers in Bengal, asserts, at 
p. 3, that, during the course of a long and assiduous practice there, he "had not ob- 
served, to the perfect conviction of his own judgment, either in or out qf the hospitals, 
a single instance of contagion" among fevers. 

37 



290 



prevailed, " that in Hospitals where patients were received 
ill of that fever, the physicians, surgeons, and other attend- 
ants, were not oftener seized with it, than the other inhabi- 
tants of those towns." 

The advocates for contagion in America, (who, though, 
pertinacious, are now very few in number,) when embar- 
rassed by the well-known and admitted fact of the disease's 
never spreading in the country, pretend that the air is there 
too pure ; which is doubtless, true, if by purity they mean that 
it is not sufficiently charged with marsh miasmata to produce 
fever; and this is also true in those hospitals, in which the 
disease cannot he propagated. And if this be their meaning, 
it only amounts to this, that their supposed contagion does 
not act, unless there be also present another very sufficient, 
and in fact, the only cause of the yellow fever. But, if they 
mean any tiling else, or mean what is commonly supposed to 
constitute atmospherical purity, this certainly does not exist 
in crowded hospitals ; and their explanation is a mere subter- 
fuge, to which persons will often have recourse, rather than 
candidly retract an erroneous opinion. 

Besides the universal exemption of the physicians at New- 
York, from yellow fever, during the epidemic of 1805, (in con- 
sequence of their having then learned, in great degree, to 
avoid the spots infested by marsh miasmata) Dr. Miller, in his 
report, mentions the dissection of persons who had died of yel- 
low fever, which, if the disease had been contagious, must 
have proved a source of danger. " Many of the physicians 
of this city," says he, " were frequently engaged in this mode 
of investigating the disease, and minutely examined bodies in 
a wry advanced state of putridity ; and yet they all continued 
in perfect health." But, besides the dissections here men- 
tioned by Dr. Miller, it appeal's that a great number have 
been made without harm in other places, and particularly at 
Philadelphia : together with many experiments upon the black 
matter vomited in the last stage of yellow fever, calculated to 
ascertain whether it possessed any contagious property. 



291 

Among these may be noticed some very remarkable ones, 
lately exhibited by Dr. Ffirth, at Philadelphia, in the presence 
of several medical gentlemen of good characters. After some 
experiments of less importance, he inoculated himself in the 
left fore-arm with the black matter which had been just before 
vomited by a moribund Yellow Fever patient ; a slight inflam- 
mation ensued, which subsided in three days, and the wound 
readily healed ; he then confined, by a black sticking plaster, 
some of the same matter, immediately after its ejection, over 
a cut in his right arm, for two days, and then found that it 
had occasioned no inflammation, the wound readily healing, 
without any formation of pus. 

These experiments he repeated above twenty times, in vari- 
ous parts of his body, with similar black matters ejected by 
Yellow Fever patients, in Philadelphia, during the epidemics 
of 1802 and 1803. He also put it into his eye, without ex- 
periencing any more inconvenience than cold water produces $ 
he also inoculated himself with the saliva and serum of patients 
under Yellow Fever, and with as little effect. He exposed 
himself to the exhalations of the same black matters, (which 
had been recently vomited) heated in an iron vessel, and ex- 
perienced no unpleasant consequence, or sensation. He swal- 
lowed the inspissated matter, which remained after this 
evaporation, made into pills, without finding his stomach in- 
commoded thereby ; and he, finally, drank two ounces of the 
recently- vomited black matter undiluted, and found it harm- 
less, after having previously taken without any bad effect, 
considerable quantities of similar matter, diluted with water. 
These nauseous draughts, and hazardous inoculations, will, 
doubtless, be thought sufficient to prove, that neither the blood 
nor the saliva of patients, under Yellow Fever, nor yet the 
black matter, the vomiting of which is justly deemed the 
most fatal symptom of the disease, possess any contagious 
property. (See Dr. Ffirth's Dissertation on Malignant 
Fever; Also New -York Medical Repository, 2d Hexade, 
vol. 2. p. 70.5 



292 



I have already noticed the constant extinction of Yellow 
Fever by frost, as one of those points in which it exactly re- 
sembles the marsh, and only the marsh, fevers. This instruc- 
tive and highly important fact is, however, capable of a more 
extensive application, for it not only proves the origin and 
nature of all these fevers, but it also proves decidedly that 
the Yellow Fever has no power of propagating itself by con- 
tagion ; and, consequently, that it never proceeds from it. In 
considering this fever as produced by marsh miasmata, we 
readily understand why (like other marsh fevers) it should 
cease when the atmosphere no longer retains sufficient beat for 
their generation and exhalation ; but this diminution of tem- 
perature could not extinguish a fever subsisting by contagion. 
Frost has no access to the apartments, and still less to the 
bodies, of persons under Yellow Fever. Upon its occuri-ence, 
fires, with additional bed clothes, secure them from its ap- 
proach, and from even the smallest interruption to those mor- 
bid secretions, or actions, by which contagion is supposed to 
be generated : and, therefore, if contagion were the cause of 
Yellow Fever, new cases of it ought to occur, during winter, 
especially as we are not acquainted with any febrile contagion, 
which is liable to be rendered inactive, merely by such a 
diminution of temperature as is sufficient to stop the progress 
of Y^ellow Fever. It certainly would have no such effect 
upon typhus fever, small pox, measles, or, indeed, any con- 
tagious disease, within my recollection. Dr. Chisholm, how- 
ever, from the resolution which he seems to have made of re- 
sisting or evading the evidence of all facts repugnant to his 
promulgated opinions, endeavours to account for this extinc- 
tion of Yellow Fever, (at p. 177) by pretending that ** it is 
admitted that Yellow Fever is the product of infection, in 
combination with a high temperature" — adding, " If it is so, 
and of this there can be no reasonable doubt, cold weather 
must have extinguished it." By infection. I presume Dr. 
Chisholm means contagion, and if so, I must deny the ex- 
istence of any such admission as he pretends, except by him- 



293 

self, and those who have adopted his peculiar opinions, in re- 
gard to the fever alleged by him to have been derived from the 
Hankey ; for he has repeatedly and strongly denied the ex- 
istence of contagion in the Yellow Fever which prevailed in 
the West Indies before the year 1793. But perhaps Dr. 
Chisholm, as the inventor of that fever, or, at least, of its 
supposed origin and contagious power, may think himself 
intitled to endow it with any qualities which may suit his own 
purpose, and, consequently, intitled to combine febrile conta- 
gion, even with that high temperature which has always 
proved destructive of it; but, even witli this incongruity, 
which I am not disposod to adopt, we may reasonably expect 
a little uniformity and consistency in his account of the pro- 
perties and effects of this extraordinary combination ; and 
require that he should not represent it as necessarily extin- 
guished by cold weather in North America after having assert- 
ed, as will hereafter be seen, that it prevailed extensively 
among the British troops in Ireland, in the winter of 1795, 6. 
As the more violent forms of yellow or marsh fever have 
ehiefly occurred in the sea-port towns of North America, as 
well as of the West Indies, and from the same causes, those 
persons who, in regard to the former, have chosen to repre- 
sent the Yellow Fever as the product of an imported conta- 
gion, have in several, though not in all cases, been able to 
discover some vessel, recently arrived from the West Indies, 
about the time when the local causes of Yellow Fever, from 
excessive heat, &c. were become powerful at Philadelphia or 
New- York, and this vessel being placed in immediate contact 
with these causes, and some of her crew being, consequently, 
soon attacked with fever, the sufferers, or the innocent ves- 
sel, to which they belonged, have been charged with the guilt 
of importing a contagious disease, and this under circum- 
stances where it has sometimes been difficult to demonstrate 
the truth, in opposition to confident statements, which, in 
such cases, are commonly made, and which, with a few of 
those omissions or mi$refpresentations> 9 naturally resulting from 



294 

party zeal, often give an appearance of probability to the 
charge. Indeed, statements of this nature have been adopted 
and published by the College Physicians, at Philadelphia ; the 
only corporation, I believe, of any kind in the United States, 
which entertains similar opinions of this subject. 

But, as the existence of a contagious quality in the 
Yellow Fever has not only never been proved or made pro- 
bable, either in the West Indies or North America, but on 
the contrary, this disease* has, in many thousands of 
instances, manifested, in the clearest and most decided 
manner, that it possessed no such quality ; and, as with- 
out if, no importation of the disease, from the West Indies, 
is possible, and propagation of it in the United States, 
sucli statements can have had no»foundation in truth, nor the 
smallest claim to serious notice. If the disease were conta- 
gious, the fact must have been indisputably demonstrated 
more than ten thousand times, considering the multitudes who 
have been victims to it, and there would long since have been 
no more doubt on the subject, than there now is of the conta- 
gious nature of small pox and measles. The uniformity ol 
nature, and the necessary connexion between cause and effect, 
will not allow us to believe in the fortuitous occurrence of a 
few rare instances of contagion from Yellow Fever, in oppo- 
sition to the immense mass of facts by which that disease has 
been proved destitute of any such quality, and the probabili- 
ties will always be a million of times greater that these sup- 
posed rare instances, have originated in ignorance, error, pre- 
judice, or falsehood, than that effects so monstrous should ever 
have really occurred.* With this conviction, I cannot resolve 
to misemploy my time by undertaking a particular examina- 
tion of the instances in which the Philadelphia College sup- 
pose the Yellow Fever to have been imported, especially as 
Dr. Caldwell seems to have sufficiently noticed and refuted 
them all, in his several publications ; and particularly in his 

* While it is notorious that the yellow fever cannot be propagated a single mile 
from Philadelphia or New-York, it is completely absurd to suppose, that it can have 
been transported by a contagious quality one or two thousand miles across the ocean 



295 

Essay on the pestilential or Yellow Fever, as it prevailed in 
Philadelphia in the year 1805, subjoined to his translation of 
Alibert's Treatise on Malignant intermittents. 

Believing that I have done enough, and more than enough, 
to prove that the Yellow Fever has no contagious power, and 
that it arises exclusively from local causes, such as have been 
described, I shall conclude my Essay in regard to the United 
St >es of America, by adducing the hitherto uncontradicted 
testimony of Mr. Jefferson (their late president) delivered by 
an official message to both houses of congress ; which affords 
a complete general confirmation, by the most unobjectiona- 
ble, as well as highest, authority of the facts stated in the 
preceding pages. The message was communicated on the 
third of December, 1805, anil the part, to which I refer, was 
in the following words, viz : 

" In taking a view of the state of our country, we in the 
first place, notice the late affliction of two of our cities under 
the fatal fever, which in latter times has occasionally visited 
our shores. Providence, in his goodness, gave it an early ter- 
mination on this occasion, and lessened the number of victims 
which have usually fallen before it. In the course of the seve- 
ral visitations by this disease, it has appeared that it is strict- 
ly local, incident to cities, and on the tide waters only, in- 
communicable in the country, either by persons under the 
disease, or by goods carried from diseased places ; that its 
access is with the autumn, and it disappears with the early 
frosts. These restrictions, within narrow limits of time and 
space, give security even to our maritime cities, during three- 
fourths of the year, and in the country always." 

Having thus established the origin and non-contagious na- 
ture of the Yellow Fever, I might here finish this inquiry did 
it not seem expedient, for many reasons, to extend it to the 
violent and very destructive fevers which, within a few years, 
have prevailed epidemically in the south of Europe, and more 
especially in Spain, and at Gibraltar, in order, by compar- 
ing them with the Yellow Fever, to ascertain their identity, 



296 

which, however manifest to my conceptions, has heen denied 
by many, and even by some who have had opportunities of 
becoming acquainted with the former, at least. 

And here I regret extremely, that, having determined to 
confine this publication to a single volume, I am under the 
necessity of laying aside a great mass of facts, whicli I had 
collected, with no inconsiderable trouble, respecting the pre- 
valence and different forms or gradations of marsh fei 
not only in Africa, and the East Indies, but in various parts 
of France, Italy, Sardinia, Sicily, Malta, Greece, &c. and 
which, had I room, ^ould greatly illustrate the subject, and 
confirm what I have already written, as well as what I am 
about to write of the Yellow Fever at Cadiz, Gibraltar, &c. 
I must, however, introduce what 1 have to say in regard to 
the latter, with a few observations respecting Rochefort, Bour- 
<leaux, and Lisbon. 

The former of these cities is nearly surrounded either by 
salt, or fresh-water marshes, so that, in summer and au- 
tumn, strangers can seldom reside there a fortnight, without 
an attack of marsh fever. On the South-east side, in parti- 
cular, are extensive fresh-water marshes, which, when the 
wind blows over them upon the city, in very hot dry weather, 
produce violent and dangerous fevers, and render them epide- 
mical at Rochefort. This was the case to a remarkable de- 
gree in 1694, when, according to Sir John Pringle, (Dis- 
eases of the army, p. 323) ••' a fever broke out in Rochefort, 
in France, which, on account of the uncommon symptoms and 
great mortality, was at first believed to be the plague. But 
M. Chirac, who was sent by the Court to inquire into its 
nature, found the cause to arise from some marshes that had 
been made by an inundation of the sea : and observed, that 
the corrupted streams, which smelled like gunpowder. J 
carried to the town by the wind that had long bhnvn from that 
quarter. About two-thirds of those who were taken ill died. 
This fever raged in June, July, and August, and then ended 
upon a great fall of rain, which purified the air, and refresh- 



297 

ed the stagnating water." Sir John Pringle refers to Les 
CEuvres Postliumes de M. Chirac, for an account of this fe- 
ver. In the Eloge of M. de Chirac, printed in the Hist. & 
Mem. de L'Acad. R. des Sciences," for the year 1732, at 
p. 121, this fever was designated as a " Maladie Epide- 
mique, qu'on appelle de Siam," (an Epidemic called Siam 
fever) doubtless from its resemblance of the Yellow Fever, to 
which that name had then been given at Martinico. Mr. Chi- 
rac is stated to have dissected the bodies of nearly 500 persons- 
who died of it, and he mentions his having generally found 
the stomach greatly inflamed, and, in some parts, mortified. 

Violent fevers, which were considered as pestilential, for- 
merly prevailed very often in the summer and autumn, at 
Bordeaux, and frequently tompelled the parliament to re- 
move to other places. The Cardinal de Sonrdis, having 
formed a just opinion of the cause of these fevers, under- 
took to drain a very offensive marsh, which then existed on 
the west side of the city. — Accordingly, two great canals 
were dug by his orders, and at his expence, to convey the 
stagnant water into the river, and a fine causeway being 
erected over the infecting spot, and planted with rows of 
elm trees, the plague, so called, ceased to appear. " L'on 
eleva dans le lieu ou etoit un Cloaque infect, une belle Chaus- 
see, que l'on borda d'Ormeaux. La Peste n'a point reparue 
depuis cette epoque." See Memoires de la Societe Royale de 
Medecine, torn. viii. p. 272 and seq. where, also, a very 
interesting report to the Society will be found, of the dif- 
ferent parts of France in which marshes abound, and of the 
fevers, intermitting, remitting, and sometimes apparently 
continued, which prevail in their neighbourhood, with greater 
or less malignity during summer and autumn. It seems, 
however, that though Bordeaux has been, in a considerable 
degree, relieved from these fevers, since the work, executed 
at the expence of Cardinal Sourdis, yet the very hot, as well 
as dry, summer and autumn of 1804, (which occasioned the 
Yellow Fever in many parts of Spain, Gibraltar, &c.) assist- 

38 



298 



ed by some new attempts at draining, begun at an improper 
season at Bordeaux, produced in this city a malignant epi- 
demic fever, which Dr. Galway, a physician of eminence 
there, states to have had very short remissions, and to have 
often terminated fatally, before the fourth paroxysm. The 
daily mortality from it is said to have exceeded fifty for 
some time. It prevailed chiefly in the quarter called the 
" Departement," where the ground is lowest, and the streets 
narrow : and this quarter was deserted by all persons in 
easy circumstances. See New- York Medical Repository, 
vol. 4, of 2d Hexade, p. 263, 4. 

Lisbon, since the earthquake, in 1755, has been, in a great 
degree, exempted from marsh fevers ; which, however, was 
not previously the case, especially in the lower part of the 
town between the bottoms of the hills and the river; a spot 
where the streets were narrow, dirty, and, as I believe, un- 
paved. In the eloge of Mr. Sanchez, formerly fii*st physician 
to the Empress of Russia, (Anne Ivanowna,) inserted in the 
4th volume of the " Hist. De la Societe Roy. de Medecine dc 
Paris, it is stated, (in a note, at p. 215) that he had witness- 
ed the ravages made at Lisbon in 1723, by a very mortal 
epidemic ; and that Dr. Bertrand, a physician, who had dis- 
tinguished himself during the plague at Marseilles, in 1720, 
being consulted by the King of Portugal, declared the latter 
to have been a different disease fnom the epidemic, at Lisbon, 
in which black vomitings were the most alarming symptom : 
(" des vonmsemens noirs etoient le Symptome le plus effray- 
ant.") Mr. Sanchez is also stated to have observed, that 
this epidemic rarely attacked women, and that the negroes of 
both sexes completely escaped it. These facts were obvious 
indications of the Yellow Fever ; but I found others more de- 
cisive, In the library of the British Museum, M. S. 4376. 
Plut. II. J. is a letter, dated Lisbon, October 30th, 1723, 
signed William Cayley, (apparently the British Consul there) 
and addressed V to Dr. Kennedy, Physician to the British 
Factory at Lisbon," in which, after mentioning " the sick- 



299 

wess," which had prevailed for some time, without any abate- 
ment ; " still continuing to take off numbers of its inhabitants, 
some of whom die suddenly, and in such a manner as has given 
cause to suspect the disease to be attended with pestilential 
symptoms," he calls on Dr. Kennedy for his " opinion" re- 
specting it, " and the observations lie had been able to make 
in the course of his practice ;" to the end that he, Mr. Cayley, 
might, according to his (( duty, transmit the same to his 
Majesty's Principal Secretary of State, in order that, if 
deemed contagious, due precautions may be taken to prevent 
the same from being introduced into his Majesty's Domi- 
nions," &c. 

To the preceding letter is subjoined an answer, signed 
Gilbert Kennedy, and dated, the 31st of the same month, of 
which the following is an extract, viz. : 

" The heat last summer began late, but continued very 
violent, and much longer tlian usual, so that the grapes, which 
were more plentiful this year than many years past, were 
burnt up, when pretty ripe. All the summer was sickly, but, 
about the middle of August, there appeared the fever which 
now reigns, accompanied with a pain of the head and loins, a 
great sickness at the heart and stomach, with reachings to 
vomit, very contagious in the lower parts of the city, going 
generally through a family, and very few families escaping it, 
especially in the close, narrow streets. The high parts are 
much freer than the low parts, and the villages and country 
houses about town are entirely free from this distemper, notwith- 
standing the great communication. The recovery is generally 
accompanied with the yellow jaundice. The only mortal 
symptom in this epidemic is the vomiting black cJwler, but this 
symptom is so rare, that I have met with it but twice in above 
a hundred I have seen with this distemper." # 

* It seems probable, from sevei-al circumstances, that the worst cases of this dis- 
ease occurred among the poorer inhabitants of Lisbon, and that Dr Kennedy's prac- 
tice being nearly confined to the British Factory, who were in better circumstances, 
he saw fewer cases of black vomitings than the Portuguese physicians. I ought 






300 

A 

66 By his Portuguese Majesty's order, there have been three 
bodies of persons dead of this distemper opened in the public 
Hospital, in all which the blood appeared dissolved like the 
thin lees of wine ; and in one of them, who had the black 
vomit, there appeared, besides, black spots upon the skin, 
which were only superficial ; the gall bladder and intestines, 
with a small quantity of black gall in them, and the stomach, 
with a large quantity of the same." 

" The reasons why great numbers have died of this distem- 
per are ; firstly, the many poor who live here most miserably ; 
and before they can procure any assistance, are carried off by 
the force of the disease, which is extremely violent for the two 
or three first days, having rarely any crisis that is usual in 
other fevers 5 — Secondly, the Portuguese method of treating 
all fevers by bleeding, morning and evening, whiie they last ; 
which has generally been pernicious in this epidemic. From 
all its appearances, hitherto, it seems very clear, that it is 
contagious only among tlwse whose bodies are predisposed by 
living in a close, noisome air, and abound with bile, or labour 
under some error in the non-naturals. Strangers, who drink 
wiue, (i. e. are intemperate) are more universally attacked 
with it than the Portuguese : among the latter no man of 
fashion has had it, nor has it yet entered any convent, except 
the Irish, although they all assist tlie sick.-* 

With so many facts, decisively proving that the disease was 
not communicated by the sick to the well, and that it only at- 
tacked persons who had been exposed to the influence of marsh 
effluvia, we might well wonder that Dr. Kennedy had not dis- 
covered the truth, did we not recollect the general dispo- 

further to observe, that Dr. Kennedy mentions, in his letter, that the weather had 
" changed several times to rain and cold," without any abatement in the distemper. 
It may, however, be presumed, that these changes were not very considerable, and 
they obviously were not lasting ; and, therefore, not likely to produce any sensible 
benefit. Moderate showers of rain, occurring with some intervals, have been found, 
in A' iei c:>. rather to promote than diminish the progress of yellow fever; probably, 
by favouring the extrication of miasmata ; and at Lisbon, in the month of October, 
no great diminution of temperature is likely to have been thus produced. 



301 

^ition which then prevailed to believe in the supposed contagion 
of fevers, without discrimination or consideration. To those 
who have formed coiTect ideas on this subject, it must now 
appear absurd, to represent a fever as being " very contagious 
in the lower parts of the city," very little so in the * high :" 
and as having no existence in " the villages and country 
houses about the town, notwithstanding their great commu- 
nication" 

I will now proceed to Cadiz. This eminent maritime city 
has frequently been afflicted by violent and destructive epi- 
demics. 

Dr. Felix Pascalis, who lately travelled over a great part 
of Spain to procure information, and ascertain facts, on this 
subject, mentions on the authority of Dr. M. Gonzales, (au- 
thor of a u Dissertation Medica sobre la Calentura maligna 
contagiosa," or Yellow Fever, which prevailed at Cadiz, in 
the year 1800,) that, " during the seventeenth century," this 
city " had been four times visited by Jtbrrid pestilences, of 
which there are monumental indications, and religious festi- 
vals, instituted to commemorate their duration, cessation, &c. 
There are, however, no such discriminating accounts of these 
epidemics, as will enable us to decide, whether they arose 
from marsh miasmata, like those of the last and present cen- 
turies at the same place, or whether they were the plague, 
properly so called ; but, considering how frequently and 
loosely the latter appellation was given to very different dis- 
eases, when attended with great mortality, the form is highly 
probable. Dr. Pascalis, however, asserts, that the Yellow 
Fever prevailed at Cadiz in 1730, and that the physicians sent 
from Seville, and who critically examined the disease, " did 
not omit to notice the (yellow) colour of the patients, and the 
vomito prieto :" and for evidence of this he refers to " Cadiz 
Illus trada, lib. 6." He asserts, also, that this disease pre- 
vailed there at other times in the last century, particularly in 
" 1736, 1744, 1746, and 1764." As authorities for the three 
first of these epidemics, he refers to the writings of Dr. N. 



302 



Rexano, Dr. Gregorio Condemina, and El Vicario Ecclesias- 
tico de la Isla dc Leon/' 

Of the epidemic, in 1764, an account has been written, in 
Latin, by Dr. Salvarez, (or Salvareza) then a principal phy- 
sician at Cadiz, by which it appears to have exactly resem- 
bled the Yellow Fever of America. He, indeed, calls it 
Vomito Prieto, because black vomitings, as well as yellowness 
of the skin, frequently occurred. Dr. Lind. also, in his 
Essay on the Diseases of Hot Climates, at p. 122, after men- 
tioning, that Fevers, similar to Yellow Fever, have appeared 
" in some of the southern parts of Europe, during a season 
when the ai* was intensively hot and unw holesome," adds, 
" this happened at Cadiz, in Spain, in the months of Septein 
her and October, 1T64, when excessive heat and want of rain 
for some months, gave rise to violent epidemic, bilious disor- 
ders, resembling those of the West Indies, of which an hun- 
dred persons often died in a day." He afterwards gi\t •> ;i 
particular account 'of the symptoms, and then informs us, 
that " the dead bodies having been examined by order of the 
court of Madrid, the stomach, mesentery, and intestines, 
were found covered with gangrenous spots, the orifice of the 
stomach appeared to have been greatly affected, the spots 
Upon it being ulcerated." He also informs us. that the dread 
of this disorder forced many people of fashion to retire into 
the country, where they remained in perfect safety from it." 
Reverting, again to this epidemic, at p. 161, he says " it did 
not extend its influence to any ship which lay at a distance 
from the city; as I am informed by Dr. Maguire, an eminent 
physician of that place. His Majesty's ship, the Tweed, was 
then at anchor in Cadiz bay ; an officer, and several of her men, 
who had been on shore, were seized with this fever : but all 
those who were sent on board the ship recovered, no bad 
symptom appearing in their fever, whilst a disease, similar 
to black vomit, and the Yellow Fever, and equally mortal, 
depopulated that large city." From these accounts, it ap- 
pears that the disease was not propagated in the country, and 



303 

that seamen, who had imbibed miasmata on shore, and be- 
came sick, did not infect others when sent on ship board : 
and, consequently, that the disease was not contagious. — Nor 
does it appear that any suspicion then existed of its having 
been imported from any other place. 

In the summer of 1800, this fever again appeared as a 
most formidable epidemic, not only at Cadiz, but in almost 
all the sea port towns of Andalusia, particularly Seville, St. 
Lugar, or Lucar, Puerto-Santa Maria, Puerto-Real, Rota, 
and L'lsla ; occasioning the deaths, as is computed, of nearly 
eighty thousand persons. It also prevailed, at the same time, 
on the coast of Barbary, particularly at Tangiers and Te- 
tuan. On this melancholy occasion, the government of Spaui 
(which, some years before had dictated certain prescriptions, 
written by the king's physician, Dr. Masdevall, to be exclu- 
sively employed by the Spanish physicians in fevers similar 
to the present, and certain opinions to be also subscribed by 
them on the subject,) thought proper to order a long and cir- 
cumstatial publication to be made as a supplement to the 
Madrid Gazette of the 28th of October, 1800, under the 
title of a "Description of the Epidemic Disease which began 
at Cadiz, — its origin and propagation — the different symp- 
toms and effects of it, and the method of cure, &c. Publish- 
ed by order of government, for the instruction of the public, 
and particularly for the notice and regulation of the prac- 
titioners of physic, &c." (See Medical Repository, vol. 5, 
p. 103, &c.) 

In this publication it is stated, that the preceding winter 
had been long and wet, the rainy season having been pro- 
longed till the month of May ; after which the summer be- 
came intensely hot, and the thermometer, from the middle of 
July, rose to 85° of Fahrenheit's scale 5* that an easterly 

* Soon aftev the epidemic in question had ceased, a pamphlet, written by Don 
Rodriquez Armesto, an officer of the Spanish navy, and entitled " Reflections on the 
Epidemic which prevailed in Cadiz, and the neighbouring towns, in the autumn of 
1800," (" Reflexiones sobre la Epidemica padecida en Cadiz," &c.) was published, 



304 

wind succeeding, lasted forty days, and being (as is usual 
there) very hot, subjected the inhabitants to extreme heat, 
with sweatings so profuse that they could obtain no relief but 
by bathing. That, about the 8th of August, bilious fevers 
began to appear ; and, from the 10th to the 15th of that month, 
many people in the quarter of Santa Maria were attacked 
with what proved to be the epidemic in question. 

Among the more general symptoms of the disease, those 
are mentioned which occur in other marsh fevers — Those of 
the more violent cases are stated to have been Subsultus ten- 
dinum, Delirium or alienation of mind, Hiccough, convul- 
sions, hemorrhage at the nose, bloody vomitings, bloody and 
black stools, yellowness of skin, petechia, and, finally, black 
vomitings, similar to those which, at certain seasons of the 
year, are endemic at Vera Cruz, Honduras, &c. (" La he- 
morrhagia de narices, la voinicion sanguinolenta por la bora, 
la melena, deyecciones de Sangre, la ictericia, las petechias, 
y ultimamente el vomito atrabiliario, a que ban querido Ilamar 
vomito prieto, semejante al que es endemico en ciertas est aciones 
del ano, en Vera Cruz, Honduras, 6cc.) These symptoms, 

after having been licensed in the usual manner. The author was, however, soon ar- 
rested on a charge of having diffused false, dangerous, and seditious opinions, and 
compelled to subscribe a formal retraction of them, so far as they were at variance 
with the creed which the court thought proper to adopt respecting the supposed im- 
portation and contagious nature of the fever in question. More than fifteen hun- 
dred copies of this pamphlet were publickly burnt; a few, however, escaped de- 
struction, and Dr. Pascalis, going afterwards to Spain, found means to procure two of 
them, and has given an abstract of their contents in the New-York Medical Reposi- 
tory, vol. v. Hexade 2d, p. 131, &c. By this abstract, it appears that the author 
endeavoured to prove that the epidemic had been produced by atmospherical and 
local causes; and that for this purpose he adduced accurate meteorological observa- 
tions, demonstrating, among other things, the extreme heat which had then pre- 
vailed." "These," says Dr. Pascalis, " were official^ as he was, by royal authority, 
keeper of the royal observatory of the Isle of Leon :" and by these it appears, "that 
the thermometer marked 95 degrees," (instead of 85") a degree of heat "equal to 
that of Senegal." 1 presume, however, that we are not to consider 95 degrees as 
the constant temperature of that season, but only as that which it sometimes attained 
in the sliade, for in the sun he states it to have often been at 112 degrees, eren in 
very damp places. 



305 

and especially tliose of which the original description is rc° 
peated in 1 Spanish, can leave no room to doubt concerning the 
natai^e of the disease. 

It is added that the most fatal symptoms were coldness of 
the extremities, feebleness of the eyelids, vomiting of matter 
like coffee-grounds, hiccough, convulsions, and coma. The 
account of the methods of treating the disease, and of the 
reasonings of the Spanish physicians, respecting its causes, 
are not sufficiently interesting for the space which they would 
occupy, were I to give even an abstract of them. It is 
stated, however, as a fact, that persons, who had lately ar- 
rived from the West Indies, owing to their being accustomed 
to the like seasons, did not suffer an attack of this epidemic, 
and that even those who had been long resident in that part of 
Spain, were, in a great degree, exempted from it ; and, on 
the other hand, that persons from Canada, and other (north- 
ern) countries, were extremely liable to it, which are circum- 
stances clearly manifesting its resemblance to Yellow Fever, 
and its want of contagion. The physicians are also stated, 
not to have observed pestilential buboes, carbuncles, or an- 
thraces, in any of their patients : and, we are told 'that, 
though several were afflicted with phlegmonous tumours, end- 
ing in ga.ngrene, others with erysipelatous vesications of like 
tendency, and some with parotids,* yet they were not of that 
kind which appertains to the true plague, and which had been 
described by Chicoineau, at Marseilles, and Samoilowitz, at 
Moscow. 

In looking for adequate causes of this epidemic, we shall 
readily find them in the situations, and local circumstances 
of Cadiz,f and the other towns of ilndalusia, in which it 

* Parotids have been repeatedly mentioned by Laneisi, and others, as occurring in 
the marsh fevers of Italy, and they are sometimes observed in the yellow fever of the 
West Indies and North A.merica. 

f The town of Cadiz is upon a point of land, which, by advancing into the sea, 
forms within itself a spacious harbour. The external part of the city, or that which is 
.nearest the ocean, is chiefly built on a rock, and is a little elevated. But the part 

39 



306 

prevailed. About the end of July, the epidemic made its 
first appearance in the Barrio of Santa Maria, inhabited 
chiefly by New Castilians, who were generally poor and la- 
borious, and it soon extended itself to the low and damp 

which is eastward, and adjacent to the harbour, is placed on very low, damp ground, 
contiguous to marshes. Indeed, almost the whole country round the Bay is flat, low, 
and swampy, and the sides of the harbour are, moreover, covered by salt pans. An 
intensely hot easterly wind blew constantly in 1800, for six weeks, over the har- 
bour, and over the other sources of miasmata just mentioned, conveying the latter 
directly upon the adjoining quarter of Santa Maria, at the south-eastern side of the 
town, where the streets are narrow and filthy, and where the epidemic appeared 
first, and continued longest. Thence it extended itself westward, exactly in the di- 
rection of the wind. 

Puerta Real, Puerta Santa Maria, Rota, and the town of Isla, (which last is sur- 
rounded by salt pans) adjoin either the harbour or the bay of Cadiz, and they all 
partook of the epidemic, as might be expected, from their low situations, and other 
circumstances. 

Not far from Rota is the river Guadalquiver, on whose left or northern bank is 
placed the city of Seville, round which the country, to a considerable distance, is so 
Iovj, that, as Mr. Townsend has observed, (Travels through Spain, vol. 2, p. 353) 
* it is frequently overflowed, and, upon snme occasions, the water has been eight feet 
high, even in their habitations. He adds, p. 356 that "the soil is rich, and being, 
at the same time very deep, its fertility is exhaustible," p. 557. That, "inconse- 
quence of vapours and miasmata, occasioned by stagnant water, and by frequent 
floods, the inhabitants of Seville are subject to tertians, and putrid fevers," (mean- 
ing the more violent marsh fevers.) What Mr. Townsend has mentioned of the 
soil round Seville is true, also of the whole country along the Guadalquiver, be- 
tween that city and S Luear, a space of twenty leagues; and, therefore, we need 
not wonder that the towns and villages contiguous to this river should, in all ages, 
have been noted for the prevalence of autumnal marsh fevers, called by the Span- 
iards, Tavardillos, or TabardiUos, and resembling what, in the West Indies, are 
commonly named bilious remittents. These TabardiUos, indeed, were, in some 
extraordinary! seasons, so much aggravated in this part of Spain as to be deemed 
the plague. (S-e Ray's Travels, p 416 ) Don Rodr. Armesto informs us, " that 
Seville is proverbially offered as an instance of annual (autumnal) plagues, where 
it never was thought necesiary to establish rules of quarantine on any description 
of vessels." (Medical Repository, 2d Hexade, vol. 5, p. 131, and seq.) In an 
ancient work, by Doctor Juan Ximenes Savariego, printed at Anteguera, in 1602, 
and entitled Tratado de Peste, 1 find the authour mentioning, at p. xvii. as thc- 
cau<-e of the fitxor winch he calls Tavardillo, pools of stagnant and corrupted l 
like that of lagoons and inundations of rivers, such as those of the Guadalqt 
at Seville, these late years. (" Estangues de Aqua estanqua, y corrompida, corao 
de lagunas, v h undacionesde Rios, como ias a avido de Guadalquibir en Set ilia es- 
tos anos passados.") He adds, that persons ill of this fever do not generally give 



307 

streets of Sopranis and • Boqueta, (near the sea gate) and 
thence to the quarters of Ave Maria, and St. Antonia ; and 
having-, by this time, attracted the notice of government, a 
meeting of physicians was convened, who, after consulta- 
tion, unanimously agreed in reporting the disease to be a 
simple synochal fever, and not contagious. Indeed, the epi- 
demic was so mild (as often happens at the early appearance 
of marsh fevers without the tropics) that even at a third 
meeting of the physicians, several of them declared they had 
not lost a single patient by the reigning disease, and many 
asserted, that of two or three hundred cases, not more than 
one or two had terminated unfavourable. At this meeting, 
however, a student of the College of Medicine, at Cadiz, 
Friar Juan de Acosta, belonging to the Convent of St. Juan 
de Dios, who had seen most of the sick brought into the 
Hospital of this convent, (adjoining the Barrio of Santa 
Maria,) declared the fever to be very acute, and of a very 
bad sort, but concurred with the others in thinking it not 
contagious.* 

Some days after this, says Dr. Arejula, " we, physicians 
in Cadiz, began to observe these fevers more seriously and 
attentively. It was natural that, having called them gastrico 
bilious fevers, void of contagion, we should also believe the 
cause of them to be general, existing in the town ; we recol- 
lected, according to the text of the great Hippocrates, and the 
observations of succeeding physicians, that much rain in win- 
ter and spring, followed by great heat in summer, like that 
which had been experienced at Cadiz, was the cause of fevers, 

it to their attendants. When we consider how unusually the rains were pro- 
longed throughout this part of Spain, in the spring of 1800, and the inundations 
which must have been thereby produced, together with the intensely hot and dry 
weather, which succeeded and lasted for a long time, we certainly need not he at 
any loss respecting the cause of this epidemic. 

* See "Breve Descripcion de la Fiebre Amarilla padecida en las Andalusias," 
&c. or a Brief Description of the Ydloxv Fever which prevailed in the Andalusias, 
&c from 1800 to 1804 inclusive, by Bon Juan Manuel de Arejula, printed in 1805., 
at the Royal Press in Madrid, Svo. pages 154. 156. 518. 



308 

epidemics, and the plague. We thought, moreover, that we 
had found another powerful cause in the kennels (Canerias) 
occupying the middle of our streets, and receiving all the 
foul water, and excrementitious matters, which we considered 
as sources of carhonic, hydrogenous, ammoniacal, sulphuret- 
ted-hydrogenous, and other unwholesome gazes." It sn 
however,- that, notwithstanding these opinions, the p3 
of Cadiz, (as those of other places have often done) soon lost 
sight of the effects of miasmata, or rather ascribe! these effects 
to a supposed contagion, extending from the bodies of the sick 
to the well. They observed, says Arejula, '*' that the p- 
nearest the sick was commonly the first attacked with the dis- 
order, and that, if it got into a house, all had it in a few d 
that it proceeded from one to the next h .end- 

ed the length of a street ;" and this coarse, which, however, 
was neither constant nor uniform, they considered as a deci- 
sive proof of contagion ; though, supposing what must have 
been true, that where the disease made this progr es s , the 
houses and persons were within the reach of miasmata, the 
facts in question might be as well explained without, as by tike 
operation of a contagious influence. 

At p. 248, Arejula endeavours farther to account for the, 
spreading of the diseas sting that the New Castill 

among whom the fever began, and who, being greatly attached 
to the second person of the trinity, and members of a frater- 
nity, bearing his name, and believing that their devoir 
fervent supplications to him, would stop the epidemic, deter- 
mined upon making a solemn procession, with his imaze. and 
obtained permission for that purpose, from the magistn 
though not until they had had recourse to menaces, which in- 
timidated the government. The procession accordingly took 
place, about the 5th of August, an immense concourse of 
the people joining therein, and it lasted seven bears : during 
which time, these unfortunate people were exposed to tin 
of a burning sun, and, under great fatigue, to all the mental 
agitations which religion or fear could produce : and 



309 

chiefly in those parts of the town where the marsh miasmata 
were most powerful. That a procession, in such circumstances, 
should produce a great extension of the disease can hardly be 
doubted ; though not in the way which Arejula, and others, 
have supposed ; for, as the well, and not the sick, joined in the 
procession, personal contagion was not likely to be present 
and active among* them. Similar processions were continued 
almost daily, and, undoubtedly, with very mischievous effects, 
until Don Tomas de Morla, as Captain General of Andalusia, 
assumed the government, and put an entire stop to them ; but 
the disease had then nearly reached its full extent.* 

At Seville the fever first appeared in the low, unwholesome 
suburb of Triana, consisting chiefly of narrow unpaved streets, 
adjoining the Guadalquiver, but on the side opposite to the 
city. It next appeared in another unwholesome suburb ; that 
of Los Humeros, also adjoining the river, and only separated 
by it from Triana ; and thence by the middle of September, 
it had extended nearly over the whole city, occasioning, be- 
fore it terminated, the deaths of fourteen thousand, six hun- 
dred, and eighty-five persons therein. 

When the physicians at Cadiz had mistaken the effects of 
miasmata for those of personal contagion, (a mistake which, 
in that crowded city, and with its numerous processions, &c. 
it might have been difficult to avoid) the next step was to 
ascertain its origin. I do not find that, on any former appear- 
ance of Yellow Fever, in that city, its introduction, from any 
part of America, had ever been suspected, or that any precau- 
tion had ever been employed for its exclusion : though, if it 
had been a contagious disease, such precautions would have 

* Don R. Armesto says the evil was augmented by making public fires in the 
Streets of Cadiz to purify the air, and thus producing an artificial heat, which pre- 
cluded the salutary effect that might have sometimes resulted from a slight refresh- 
ing breeze: that it was augmented also by the dread and panic of reported conta- 
gion, and by numerous acts of religion, e. g. by the funeral processions which suc- 
ceeded every death; by the " holy images, relics, and sacramental objects which 
were incessantly offered to the eyes of a dejected people," and by " thundering 
preachers solemnly warning every one of his approaching dissolution.'" 



310 

been highly expedient, considering how often the galleons, 
and other ships from Porto Bcllo, Havanna, and other parts 
of the West Indies, had been attacked by the disease, in re- 
turning thence to Cadiz ; as happened to the squadron, &c. 
under Don Lopez Pintado, mentioned at p. 337. 

But in the summer of 1800, the government, as well as the 
inhabitants, of Cadiz, appear to have adopted the belief of an 
importation of the supposed contagion from America, and a 
ship, called the Dolphin, belonging to Baltimore, was gene- 
rally and decidedly selected and accused as having been the ve- 
hicle o£ this mischief : and reports were fabricated, by which 
three persons were stated to have died of Yellow Fever onboard 
the Dolphin, during her passage, and what had been supposed 
to be the first cases of the fever at Cadiz, were d e cla r ed to hate 
occurred in different individuals, who had all directly communi- 
cated With the Dolphin, or some of her crew : and other sai- 
lors belonging to the same ship were said to have found their 
way up the Guadalquiver, through St. Lugar, (in which 
town however, the disease did not appear until the middle of 
September) and, by lodging in the suburb of Triana, at 
Seville, to have produced the Yellow Fever there, some i 
before its appearance at Cadiz. These stories, in point of de- 
tail and seeming accuracy, were such as Dr. Haygarth, by 
his letter of the 23d of May. 1T99. solicited Professor Water- 
house to procure for him respecting the importation of Yellow 
Fever into Philadelphia, &c and they were circulated gene- 
rally, and with great confidence,* so that Don Pablio Yali- 
ente, lntendant of Cuba, who had chartered the Dolphin, to 
bring himself and his family to Spain, was. notwithstanding 



* These stories were adopted, and most of them published, in substance, by Pro- 
fessor J. X. Berthe, of Montpellier, who was sent by the French government, 
with two Other physicians (M. it. Pierre Lafabrie, and Victor Broussonet,) into 
Spain, to ascertain tacts and collect information, respecting the epidemic of \ 
tasia, in 1800, of which he has given a Precis Historique, in a! > 
printed at Paris, in 1S02. Some account of the stoi 
phin, may he found at and between p. 5-2 an 



311 

his rank and connexions, arrested upon a criminal charge, 
tried before the Royal Audienza, at Seville, and, after a full 
investigation, and eleven months imprisonment, fully and 
honourably acquitted of having introduced the Yellow Fever 
at Cadiz ; and he was, probably, as a compensation for the 
injustice he had suffered, afterwards promoted by the govern- 
ment. In the course of this prosecution, it was juridically 
proved, that the Yellow Fever had not appeared at the Hava- 
na, whence the Dolphin sailed in May, 1800, until some time 
after her departure ; and though she touched at Charleston on 
the 2d of June, and sailed thence on the 10th of that month, it 
was, (in consequence of an application from the Spanish govern- 
ment,) certified unanimously, at an extraordinary meeting of 
of the Medical Society of South Carolina, on the 5th of 
April, 1801, (twenty-two respectable physicians being present) 
that " to the best of their knowledge, no Yellow Fever had 
existed in that town, or in the Port of Charleston, prior to 
the 20th of June, in the year 1800." They also declared, on 
the ground of specified facts, their conviction that the disease 
in question had never been propagated by contagion. It was 
also proved, and particularly by the testimony of Don Jose 
Caro, a Spanish physician, who had returned as a passenger 
on board the Dolphin, and was examined, on oath, by the 
judges at Seville, that the diseases, of which the three sai- 
lors* had died on board of that ship, were not of the nature of 
Fellow Fever,] but different diseases, of which an account 
was given. It was, moreover proved, that no symptoms of 
the Yellow Fever had appeared in any person on board the 
Dolphin, and, consequently, that the disease could not have 
been introduced by that ship. Dr. Arejula has, therefore, 
deemed it proper to reject the stories concerning the Dolphin, 
and to confess that it was impossible to ascertain whence the 

* Professor Berthe, at p. 340 of his volume, has multiplied these deaths to three 
times three, or nine. 

f See Dr. Fascalis's Account of this Prosecution, &c. in the New York Medi- 
cal Repository, vol. 9 p. 386, 7, and 8. 



312 

epidemic was derived. He, however, represents it as having 
been spread by contagion from Cadiz, to the other places 
where it prevailed, and, as having been exactly similar to the 
Yellow Fever of America, (seep. 153) in which his opinion 
agrees with that of Professor Berthe, Dr. Gonzales, and 
other Spanish physicians, by most of whom it is now called, 
66 la Fiebre Jmarilla" or the Yellow Fever. 

After the treatment which Don R. Armesto and his publica- 
tion underwent, it can hardly he expected that any Spanish 
author would openly profess to disbelieve the contagious na- 
ture of this epidemic, or that I should be able to adduce 
Spanish authorities to support my own opinion on that point.* 
and I shall, doubtless be thought to have done enough, if. 
availing myself of the facta smarted or admitted ..for other 
purposes) by those who represent the disease as bring con- 
tagious, I demonstrate the contrary from them ?ery I 

Among the facts in question, one which has been much in- 
sisted upon by the contagionists, and particularly by Profi 
Berthe, is what may be called the Geographical Pi 
the disease, which, though readily explained, by supposing it 
to proceed from miasmata generated in particular situations 
and wailed in one direction by a long-prevailing wind 
utterly inexplicable upon the supposition of its resulting from 
personal contagion, because, in givat cities, men do not al- 
ways communicate, in the slightest degree, with their next 
neighbours, and they never communicate exclusively with 
these, but very often with persons at considerable d 



* Don Armesto is not the only person who has been punished in Spain for ex- 
pressing his sentiments on the subject of Yellow Fever I /odor, now Sir 
Fellows, who went from Gibraltar to Malaga and Cardis, 
formation on this subject, after mentioning, in a letter to me, (dattd Alg 
Bay, February -27, 1S06) the obstacles which he had encountered, 
est " was the mystery and secrecy with which all the information I obtained was 
enveloped." — I found the Spanish plnsiciaus very will 

but I could not get them to tell me a fac- 

tors, who give their opinion too freely, about thenati. se, are bttnubeiL 

as was the case of one at Malaga, and another at C; 



SIS 

and in various directions, by whom the effects of personal 
contagion would soon be felt, and spread on all sides. " It 
was distinctly observed, says Professor Berthe, at p. 74, that 
the malady affected to seize, with scarcely any interruption, 
all the houses which were situated on the same side of a street, 
and tli at it rarely passed over to the other side, where the 
streets were wide, and well aired. In some parts of the town, 
(he adds) the distemper has been seen to stop, as it were, for 
a time, as soon as it had reached to houses standing in a pub- 
lic square, and even to retrograde, with respect to the direction 
in which it had previously advanced, by appearing in the ad- 
joining houses, rather than in those which were separated by 
the breadth of the square." These Mr. Berthe has strangely 
conceived to be clear indications of the contagious nature of 
the disease; — as if the next neighbours, on the same side of a 
street or square, had been the only persons in all Cadiz who 
visited, or approached, each other. And here I must remark, 
that, though the professor represents his supposed contagion, 
as so feeble and inert that it could not make its way from one 
side of a street or square to the other, he has most inconsist- 
ently described it in several parts of his work, and particu- 
larly in his Letter to the French Ambassador, at Madrid, as 
possessing an incalculable activity. And it is by this, and the 
supposed rapidity of its extension, that he endeavours to ac- 
count for the nearly simultaneous appearance of the disease at 
places so distant as Cadiz, Seville,* and other towns and vil- 
lages along the river Guadalquiver ; an effect which could 
have been produced only by miasmata becoming abundant in 
those low situations, and acquiring maturity nearly at the 
same time. 

Another proof of the non-contagious nature of this epidemic 
is derived from the fact, (admitted by Professor Berthe, and 
all the contagionists) of its not having spread in the towns or 

* Dr. Pascalur asserts, that the epidemic first broke out " on the 23d of Jaly, 
in the suburb of Triana, in Seville, a little before it was noticed at Cadiz. " See 
.Medical Repository, vol. 9, p. 389. 

40 



314 

villages, which are at a small distance from the low grounds 
of the Guadalquiver, particularly the elevated village of Al- 
alia de los Panaderos, which is distant only three or four 
miles from Seville, and takes its name from the occupation of 
its inhabitants, who are Bakers, and make all the bread con- 
sumed in Seville. " There was, consequently," says Mr. 
Berthe, (see p. 157, 8.) M a daily communication between 
Mcala and Seville, through a considerable number of indivi- 
duals, and this communication was never interrupted, not 
even during the time when the distemper was committing the 
greatest havoc in the town ;" and when, out of a population of 
80,000 persons in Seville, above 76,000 were attacked by the 
Yellow Fever.* He adds, that, according to the report of 
the physician at Alcala, twenty-four persons had had the dis- 
ease in that village, who all brought it thither ; (" Pont ap- 
porte du dehors") that eighteen of these had died ; and yet, 
that in no instance had the fever been communicated there, 
from one individual to another, f Professor Berthe also men- 

* When Sir James Fellows returned to England, in 1806, 1 mentioned to him, 
what Professor Berthe had stated respecting Alcala, and he confirmed the state- 
ment, as a tact, of Avhich he had been informed, on good authority, in Spain ; 
adding, that the like had happened, in 1804, at two villages near Malaga, prin- 
cipally inhabited by Bakers, who supplied that city with bread ; the persons 
who brought and delivered the bread at Malaga, sometimes remained there all 
the following night, and, in that case, were afterwards very commonly attacked 
with the Yellow Fever, at their own houses ; but the fever tvos never propagated 
by them to any other person. He made a visit to one of these villages, (Turriano) 
situated upon the declivity of a hill, westward of the Agual Medina, about fire 
miles from Malaga — a situation which, being like Alcala, removed from all pro- 
bable sources of marsh effluvia, may account for the non-appearance of contagion 
in those who sickened there, much better than a supposition mentioned by Sir 
James, of its having resulted from the burning, in the Bakers' ovens, of certain 
aromatic herbs, collected in the mountains. Had they burnt all the spices of the 
Molucca islands, I am persuaded they would have proved as useless, for any such 
purpose, as the fires made in the streets of Cadii were found to be, in 1800. 

f M. Berthe endeavours to account for the non -communication of the disease at 
Alcala, by supposing that the fires of the Bayers' ovens had produced a greater 
ventilation in that village, though, in another place, he acknowledges that the fires 
made in Cadiz, to produce a similar effect, were not of the least benefit ; and, in 
towns where the true plague has become epidemic, the Bakers, instead of being 



315 

lions the small town of Scipiona, as one in which the fever 
did not appear, though hut a few miles from San Lucar, 
where a sixth part of the inhabitants died of it. Scipiona 
had, however, the advantage of being higher and at a greater 
distance from the low grounds adjoining the river. M. Berthe 
also mentions the large elevated town of Medina Sidonia, 
between Cadiz and Gibraltar, at the distance of eight miles 
from the salt pans of La Isla de Leon, as another to which the 
epidemic did not extend.* 

Another fact, stated by M. Berthe (at p. 69) on the autho- 
rity of a principal magistrate at Cadiz, (Le Procurador Mayor 
Don Miguel de Irribaren) is, that, on the day after the great 
procession, which I have mentioned at p. 309, the number of 
sick was increased by between five and six thousand new at- 
tacks : and these are supposed to have been the effect of con- 
tagion received during the procession. But it is utterly impos- 
sible that any contagion yet known, should have operated so 



Exempt, have been found the greatest sufferers. This is mentioned, in regard to 
the plague at Toulon, in 1721. See Traite de la Peste, 4to. p. 49, 50. In my 
copy of this work, there is a marginal note to this part of it, in the hand-writing of 
Dr. Hussely in which he states, that " Bakers were remarkably subject to the 
plague at Aleppo, not from any peculiarity in the contagion, but from circumstan- 
ces favourable to infection." 

* It ought to be mentioned, that in the following year, 1801, when the Yello\v 
Fever is understood not to have appeared in any sea-port town of Andalusia, it 
prevailed, to a considerable extent, in a particular quarter of the inland town 
of Medina Sidonia, and as may be presumed, from the agency of marsh miasmata, 
rendered active by causes which I am not able to explain, not being sufficiently 
acquainted with the local circumstances cf the place, and the state of its atmos- 
phere, at that time. There was, however, no suspicion of any new importation, of 
contagion, and even if the epidemic of the preceding year at Cadiz, &c. had re- 
sulted from contagion, and that contagion had been capable of subsisting in a dormant 
state, over the winter, and becoming active in the following summer, the effects of 
its activity would, doubtless, have been manifested in the places where there had 
been most of it, and where its ravages had been greatest in the year 1800, and 
not in a town where it had not existed. On that occasion, however, guards were 
employed to obstruct all communication with the sickly part of Medina Sidonia, 
and as the miasmata could only reach to a certain extent, the fever did not pre- 
vail in those quarters which were too remote, and the guards naturally had the 
credit of having kept the epidemic within certain limits. 



316 

suddenly, though it has been ascertained that marsh miasmata, 
in particular situations, do sometimes produce fever within 
even less than twenty-four hours ; and that these new cases, 
as well as the epidemic, generally resulted from the latter 
cause is abundantly manifest from its similitude in every 
respect to what have been heretofore noted and ascertained to 
be the peculiar characteristics of marsh and Yellow Fever; 
especially the following : 

1st. Its having been preceded by that state of weather which 
notoriously renders marsh effluvia most abundant and noxious. 
That tli is was the case, to a remarkable degree, ia admitted' 
by all : and Professor Berthe was so sensible of it, that, at 
p. 366, he does not scruple to admit, that if no contagion had 
been introduced at Cadiz, in 1800, the causes of disease there, 
and in other parts of Andalusia, were such that a violent 
bilious epidemic, or marsh fever, must have been produced by 
them, similar to that which was, at the same time, produced 
by these causes at Cette, and other places along the Mediter- 
ranean coast. He is, indeed, not willing to consider the fever 
at the latter places as exactly similar to the epidemic of Cadiz, 
&c. because he wishes to have it believed, that contagion had 
co-operated with the other causes in producing this epidemic, 
a? id he represents the fever at Cette, as not having been con- 
tagious. But, after attentively considering his own descrip- 
tions of both, it is evident that, at the utmost, they could only 
have differed in (a small) degree, and not in their nature,* 

2d. By the greater prevalence and mortality of the dis- 
ease, in situations nearest to the sources of marsh miasmata. f 

•Don Kodr Armesto considers the Mediterranean fever as resembling that of 
Cadiz, and says, the same epidemical constitution of the atmosphere extended along 
the Mediterranean, as far as Leghorn and Genoa, adding that, in the latter, ■ where 
150 persons died every day offtSvm Fever, no American vessel could be accused 
of importing it, as Genoa was, long before, closely besieged by land, and blockaded 
by sea. ' 

fDr. Berthe, for himself and his colleagues, makes a general admission of th« 
fact at p 161. " The epidemic, (says he) «h angularly rapid in its progii ss. aud 
ahi-.ys tnost destructive, in low and humid situations -\ might, (he adds) eke 
on tfiis subject the ravages committed by the distemper in several village* built on 






817 

This was strongly manifested in the Barrio of Santa Maria, 
which is stated, even by Mr. Berthe, to have been (i le pre- 
mier Foyer," of the disease, which, (he adds) in that spot, 
produced " une mortalite effroyable," (see p. 162.) The ma- 
lignity was, indeed, such, that the proportion of deaths 
among those who were attacked, exceeded, by ten times, 
that of some other situations. Here the disease not only be- 
gan first, but lasted, after it had ceased in all other parts of 
Cadiz. A similar difference, in respect of situation, was 
observed at Seville, where, according to M. Berthe, (p. 103) 
only one in eighteen of the sick died in the wider and more 
elevated streets, while, in those which were damp and low, 
as in Triana, and Los Humeros, the mortality amounted to 
one-third, and even to one-half; and this difference was ob- 
served, not only in regard to streets, but to single Jwuses, in 
some of which, from their situation, the disease was much 
more fatal than in others. Such wide differences would not 
have accompanied a disease produced by contagion. 

3d. By the influence of extreme hot weather, in exaspe- 
rating this epidemic, and of cold weather, in mitigating, 
and finally producing a cessation of it. These effects were 
generally observed ; and Professor Berthe has mentioned 
them distinctly, and in very strong terms, particularly at 
p. 154 and p. 324. 

By the marked seventy with which it universally attacked 
all strangers from colder climates, particularly those from 

the banks of the Guadalqidver, and compare them with the very different results 
which it had in other villages at a small distance, but farther from tlie river, or stand- 
ing on rising ground, at a greater or less elevation. We have procured the most ac- 
curate accounts in this respect, which it is useless to mention in detail, as they all re- 
semble each other." This is in exact conformity with the experience of former 
times. Dr. Lecaan, who, in the reign of Queen Anne, was physician to a British 
army sent to Spain, in his " adviee" to that army, p. 5, says, " It is generally obser- 
ved, that all over Spain, dtve?Ung houses or towns built near any river side are al- 
ways unhealthy, and much worse near a marshy ground, where fevers or agues are 
very common, and more frequently mortal or difficult to cure than in any other part 
of the world," 



318 

England, Germany, and Prussia, as specified by M. Berthe, 
at p. 175, 323, and those from Canada, as mentioned in the 
publication made by the Spanish government.. And, on the 
other hand, by its invariably sparing negroes, Creoles, and 
persons who, after residing for some years in situations be- 
tween the tropics, had recently come from them, as is men- 
tioned by Professor Berthe, at pages 166, 7, 8, and 9 ; also 
p. 323. 

With all these prominent features, it is impossible not to 
recognise in this epidemic, a marsh or Fellow Fever, and 
consequently, a fever destitute of contusion. 

A similar fever less violent, and much more limited in its 
attacks, occurred again at Cadiz and Seville, in the months 
of August and September, 1801, and, for some weeks, excited 
considerable alarm ; but the weather proving to be neither so 
hot nor dry as in the preceding year, the fever did not increase, 
and was finally deemed a Tabardillo,* or bilious remittent, 
such as occurs to a greater or less extent, almost every year, 
in the southern parts of Spain, as well as on the coast of 
Barbary. 

Though the Yellow Fever had, in the year 1800, prevailed 
at Malaga, and some other Spanish towns on the Mediter- 
ranean coast, it was with much less violence and mortality 
than in Andalusia. It recurred, however, at the first of these 
towns, with great malignity, in 1803, so as to occasion the 
deaths of 12,000 persons : and, in the following year, it pre- 
vailed there again with almost unexampled violence and fa- 
tality ; it being computed that more than twenty-six thousand 



* If I am not mistaken, the TabardiUo (though often used in a more general sense 
strictly means the fever, which Burlet, (in his Dissertation sur les Maladies des Es- 
pagnols, Ann. 1714,) has named Tritseophia Syncopalis ; having paroxysms which re- 
turn every day, but correspond alternately with each other, as in the double tertian 
Riversius calls it Tertiana maligna pestilens. It is said not unfrequently to proTe 
mortal at the second or third paroxysm. Dr. Pascal is says that, during the epidemk 
of 1800, the Spaniards, not being aware of the absolute unity of the disease, consider- 
ed the milder cases of it as Taberdillos. See Medical Repository, vol. 9, r 



319 

of the inhabitants of Malaga, died in that summer and au- 
tumn, of this fever. 

In 1804, as well as in the preceding year, this epidemic 
appeared first, and prevailed most generally and destructively 
in a low Suburb, called the Barrio de Perchel,* and in other 
contiguous low parts of the town, liable to great humidity by 
inundations, and percolations of water from the river Chmdal- 
medina. And, as the summer of this year, in the south of 
Spain, France, and Italy, resembled, and even surpassed that 
of 1800, by its excessive heat, and great want of rain, so the 
Yellow Fever prevailed, not only in Malaga, but Cadiz, 
Gibraltar, Carthagena, Alicant, and even as far eastwards as 
Leghorn, and in all nearly at the same time. 

It seems, however, to have appeared a few days earlier at 
Malaga, than at any of the other places, probably because, 
from local circumstances, the heat of this city (and especially 
with the Terral, or land wind) is often greater than in any 
other part of Spain. (See Carter's journey from Gibraltar 
to Malaga, vol. ii. p. 406.f) 



• Malaga is situated at the foot of a mountain, and in a very loiv valley, through 
which a stream passes, called the Guadel-Medina. This is properly a torrent, which 
is sometimes nearly dry, but sometimes is so full as to overflow its low banks, and 
inundate several parts of the town on one side, and the whole of the suburb called 
the Barrio d? Perchel, situated on the other side. I have been informed by Sir 
James Fellows, who visited Malaga in 1805, that the sites of the houses in this su- 
burb, and in many parts of the town, are from two to three feet beloto the bed of the 
river; aud that, when the stream is full, the water enters into all the lower apart- 
ments copiously. 

f He tells Us at the next page, that in 1637, " 20,000 inhabitants of this city died 
ofthe/>/a§"Me, which visited them again twelve years after and carried away the 
greater part of the citizens.** Probably this plague was an epidemic Yellow Fever, 
like that of 1804. The only objection to this supposition is, that Mr. Carter men- 
tions the plague of 1637, as appearing in the month of May, which according to the 
old style then U9ed, would have extended to the 10th of June. But an extraordina- 
ry concurrence of circumstances has, in that part of Spain, sometimes produced in- 
tensely hot weather, even at an earlier period . The like happened at Charleston, 
South Carolina, in the year 1732, when a most violent and destructive Yellow Fever 
appeared there in the month of May, though that disease commonly does not begin 
to prevail epidemically in that city till August. 



320 

ICarly in August, the deaths had become very numerous at 
Malaga, and had produced great alarm : bit a diminution in 
the heat of the atmosphere having lessened their number ; the 
physicians, on the 14th of that month, subscribed a certificate, 
declaring that " no epidemic then existed in Malaga, and 
that the disease which had appeared, was only a sort of inter- 
mittent fever of a malignant character, similar to that which 
prevailed in other parts of Spain ; and that its malignity 
already so much abated that only five out of twenty then died, 
though, at its commencement, it had proved fatal to fifteen 
out of twenty !" (a strong proof, indeed, of m ' It 

happened, however, that almost immediately after tins certifi- 
cate, the weather again became intensely hot, and the deaths 
increased so rapidly, that, on the 21st. they amounted to 148 
in that single day. The fever was then deemed not only con- 
tagious, but pestilential: and effectual measures were unfor- 
tunately taken to cut off all communication between the city 
and the country, by which the miserable citizens were com- 
pelled to remain exposed to the morbid exhalations, which 
caused the disease, and ultimately to perish by it, (as the 
greater part of them did) and, in the mean time, they weir 
deprived of the necessary supplies of food. 

As the disease had made its first appearance this season at 
Malaga, and as no body ventured to doubt of its contagious 
nature, alLthe other Spanish towns (fifteen in number, besides 
villages) where it soon began to rage, were presumed to re- 
ceive the contagion from the former city ;* and (which is per- 
haps, still moi^ extraordinary) Jrejula, who admits (p. ISS) 



* Dr. F. Pascalis mentions (Medical Repository, vol. 9 p 591) that the phv«iciao 
who, at the beginning of the epidemic, in Malaga, in 1804, first announced its true 
character, " became so disgraced as to be compelled to exile himself. In thre. 
he arrived in Cadiz, where his servant soon died with Yellow Ferer ■ This happen- 
ed exuciiy at the lime when other sufficient causes had rendered the miasmata ao- 
tive at Cadiz, and, the Yellow Fever soon becoming prevalent. M in ISfO, it wasas- 
W il to this servant, and, oi" course, to coutagiou, not miasmata, received H him at 
Malaga. 



321 

that this was the true Yellow Fever of America, pretends that 
the contagion of it was introduced at Malaga, by two brigs which 
entered that port, not from America, but from Marseilles, on 
their way to St. Domingo ; so that the deaths of 120,000 per- 
sons by this disease, during that year, in Spain only, are thus 
derived from a French port, where quarantine regulations 
are executed with the great exactness, and where no such dis- 
ease existed. But, after having so often proved that this fe- 
ver is void of contagion, and incapable of importation, I shall 
not be expected seriously to examine this charge against 
Marseilles, nor the allegations respecting other places said to 
have become infected by sommunicating with Malaga ; all of 
them, so far as I have been able to ascertain their local cir- 
cumstances, having had within themselves such sources of 
marsh miasmata, as in such an extraordinary season might, 
with the experience of former years, have been expected to 
prove highly morbific* Instead, therefore, of exhausting the 
patience of my readers, by describing sources of marsh mi- 
asmata in Spanish towns, where their existence has been 
proved by the frequent recurrence of marsh fevers, I will pro- 
ceed directly to a place where these sources are less obvious, 
I mean 

GIBRALTAR. 

And here it is to me a matter of regret, that in describing 
the situation, and local peculiarities of this interesting spot, I 
I am, in regard to many circumstances, compelled to rely on 
my own observations, made at times, when, not foreseeing 

* Carthagena, besides other sources of miasmata, has within about a quarter of a 
mile of its bastion, a very extensive swamp, called the Almojar. Mr. Townsend, afc 
p 137, of the 3d volume of his Travels in Spain, says of the diseases of Carthagena, 
that "the most endemical are intermittent and putrid Fevers. These arise from 
the proximity of the extensive swamp, already mentioned, containing many hundred 
acres, which might easily be drained, so as to produce the most luxuriant crops."— 
He adds, " in the year 1785, during the three autumnal months, they lost 2500 per- 
sons, and, in the succeeding year, 2500 more ; yet the Almojar remains undrained. p 
To these deaths may be added 14,940 others, produced in 1804 only, by the same 
marsh fever, aggravated into the form of Yellow Fever. 

41 



322 

their connexion with this subject, my examinations and in- 
quiries were not so minute and particular as they would other- 
wise have been. 

The town of Gibraltar is built upon a narrow strip of nearly 
fiat ground, extending along the foot and western side of a 
stupendous rock, (in some places between 2000 and 3000 feet 
high) which, at its summit, is very sharp, and runs as a longi- 
tudinal ridge, nearly a mile and a half from north to south. 

This rock, on its eastern side, forms an abrupt and almost 
perpendicular descent, from top to bottom ; but, on the western 
side, towards the town, its declivity is but moderately steep, 
presenting, according to my best recollection, an inclination 
of about thirty-five degrees. So that all the rain discharged 
from the clouds, attracted and arrested by the summit of the 
rock, and falling upon a declivous surface of, I believe, at 
least 400 acres, excepting what escapes by evaporation, or is 
absorbed by the scattered palmettos, grasses, and plants 
which find means to grow on the rock, must descend to the 
town in addition to that which falls directly upon its own sur- 
face. But a part of this rain water is intercepted at the bot- 
tom of the declivity by a large ancient stone Aqueduct, five 
feet deep, and covered by an arch ; having on that side, which 
is nearest to the acclivity of the reck, a considerable number 
of apertures, called weep holes, through which the descending 
water, after percolating through the sand, enters the Aquae* 
duct, for the. use of the garrison. This Aquseduct begins 
about half way between the south portgate and the new bar- 
racks : and is continued close along the side of the read, into 
the middle of the town. It, how ever, now receives less water 
than formerly, because General O'Hara, to form a parade for 
exercising the troops, caused a ridge of sand w iiich ran paral- 
lel with the Aqueduct, and threugh which water was perco- 
lated into it, to be levelled and covered by a mixture of slate, 
hard clay, &c. which have formed an impenetrable surface, 
that a considerable portion of the falling water, which used 
to find it-; way into the Aqu&duct, now runs over it, into the 



323 

town. How far this change may have contributed to increase 
the quantity, or virulence of the miasmata, in the summer of 
1804, I am unable to decide. 

The whole Peninsula of Gibraltar consists of a- rock, co- 
vered more or less, in particular spots, with earth. Conse- 
quently, the town itself is placed on the rock which extends 
even to the water's edge ; and this being nearly impenetrable 
by water, must, in that respect, produce the effect of a sub- 
stratum of hard clay, and hinder the escape of moisture, ex- 
cepting only those excesses of it, which the soil cannot absorp 
or retain, and which must, consequently, descend to the ocean, 
whose level is, I believe, thirty or forty feet below that of the 
streets, running generally with a small descent towards it. 
The town, therefore, though elevated in regard to the sea, is 
very low when compared with what may be called the moun- 
tain behind it : and, as the great quantities of vegetable and 
other matters constantly brought into the town, to supply the 
various wants of the garrison, and the other numerous inhabi- 
tants, must even from their refused or useless parts, afford 
matters sufficient (with water) to produce abundant miasmata, 
especially when assisted by the fragments of vegetables growing 
upon, and frequently washed down, from the mountain,* we 
might, I think, very reasonably expect in that climate, and in 
such a situation, that marsh fevers would sometimes become 
prevalent.! It is, however, I believe, true that agues do not 
often occur in. the town of Gibraltar ; probably, because in 
ordinary seasons, the quantities of rain water which either fall 



* Sir John Pringle, in his work on Hospital and Jail Fevers, (p. 46) says, " I 
have observed, in a fixed camp, that the rottenness of straw concurred to affect the 
health of the men, as was visible by a general convalescence\x\>on changing the ground." 

* I have already referred to Dr. M'Lean's testimony that fatal miasmata .arise 
where there are no very certain appearances of marshy soil, and to the instances 
of this which headduces from the fevers at Cape Nicholas Mole and St Mark's. 
Many others might he added to these, if necessary. Even Dr. Chisholm, atp 122, 
of his second volume, has mentioned a production of Yellow Fever, in 1798, at 
Fort Edward, in Martinico, by percolations of water, through the sides of a bank> 
lodging under " the floor of the barrack." 



324 

directly upon the town, or find their way into it, from the 
declivous surface of the rock or mountain, are so great, as to 
wash into the sea, the decomposing organized matters con- 
tained in the soil, before they have had time to form no,x 
miasmata ; and it seems to be only in seasons when there is 
but little rain for six or eight weeks, that such miasmata 
can, in Gibraltar, acquire maturity and force sufficient to 
manifest themselves extensively. 

But, besides the materials necessary or conducive to the for- 
mation of miasmata, there is, at Gibraltar, sometimes a co- 
operation of causes suited to render them extremely powerful 
and virulent, especially when, as in 1804, an intensely hot le- 
vant or easterly wind prevails during a great part of the sum- 
mer, with no rain excepting a few slight showers, just suffi- 
cient for the extrication or evaporation of these miasms in a 
state the least diluted, or most concentrated with such a wind 
intercepted by the perpendicular acclivities of the mountain 
on its east side, the atmosphere of the town of Gibraltar 
would remain nearly stagnant,* and the exhalations from the 
earth, instead of being blown upon the ocean, would be hi 
accumulate in the narrow streets, and produce the most vio- 
lent form of marsh fever. To these causes, we may add the 
great augmentation of temperature, occasioned by the raj 
an unclouded summer's sun, reflected upon the town, during 

the hottest part of the da> . from the acclivities of the rock 

Even the ordinary temperature of the atmosphere in this town 
appears to be very great. Dr. Lind (on Preserving the 
Health of Seamen) says, •• the heat at land, in Gibraltar, ex- 
ceeded that in the ship upon the water, by eight or ten degrees 
and also that of Oran in Africa, by six degrees f* and he adds, 
•'• that the common heat, during the summer, in the garrison 

* Dr. (Lind, on Preserving Health iu Hot Climates, p. 117) writing of Port Maho. 
which is almost surrounded by high mountains, in the Bay of Mexico, says, 
Stagnated air thence becomes so unwholesome, that men, after being there a few 
days, are suddenly seized with violent vomitings, head-aches, delirium, &c. at 
two or three days more, the dissolved mass of blood issues from every pore " 



325 

of Gibraltar, is from 79° to 87 degrees. See p. 168. We 
need not, therefore, wonder, that though agues do not often 
occur at Gibraltar, the more violent forms of marsh fever 
frequently prevail there, during the summer and autumn, as 
is well known to be the case. 

The late Dr. Donald Monro, in his Observations on the 
means of preserving the Health of Soldiers, vol. 1, p. 23, 
says, " at this place (Gibraltar) June, July, August, and Sep- 
tember, are constantly hot, and the two last sultry ; and in 
these months the garrison, and inhabitants, are subject to bilious 
and putrid* disorders ; but new comers seldom escape, and 
have them in a violent degree. 

This statement by Dr. Monro, having been shewn by me to 
Sir James Fellows, on the 3d of June, 1806, was by him con- 
firmed, on the ground of his own experience, at Gibraltar, in 
the preceding year, and also on that of documents which he 
had collected there respecting the state of health of the garri- 
son in former years. 

Mr. Pym, Garrison Surgeon at Gibraltar, and long a resi- 
dent there, mentioned to me on the 27th of November, 1808, 
that, during the hot months, persons died there every year of 
fevers, which, by his description, resembled the bilious remit- 
tent or Yellow Fevers of the West Indies ; the patients often 
becoming yellow before death ; and, it appears from the 3d 
volume of Dr. Trotter's Medicina Nautica, (p. 420 and seq.) 
that a similar fever prevailed, to a considerable extent, at 
Gibraltar, in the autumn of 1799.f 



* The words " bilious and putrid," as here used, were apparently intended to 
signify fevers resembling the Yellow Fever of the West Indies, though, perhaps, 
less exasperated. 

| In the year 1766, orders from his Majesty being sent to the governors and com- 
manding officers at Gibraltar, Grenada, Antigua, Jamaica, Senegal, and North Ameri- 
ca, " to transmit a report of the most eligible season for landing troops in each of 
their respective districts," so as to avoid, as much as possible, the inconveniences of the 
climate," answers were returned to this requisition by the several governors, under 
their signatures, after proper consultations and inquiries : and a copy of these an- 
, swers having been transmitted, by the Adjutant-General, on the 29th of May, 1809, 



326 

With such evidence of the morbid effects of marsh miasmata 
at Gibraltar, there can be no doubt that, however produced, 
they often exist in that place, during the summer and autumn ; 
and when, by the unprecedented heat, and drought of these 
seasons in the year 1804, the marsh fevers of Cadiz, Malaga, 
and other towns, but little removed from Gibraltar, had been 
converted into the most violent epidemical Yellow Fever, can 
it be surprising that this should also have happened at the lat- 
ter of these places ? 

Many stories, contradicting and refuting each other, \ 
confidently propagated respecting the supposed introduction, 
at Gibraltar, of the contagion to which this was by many at- 
tributed. 

Among these stories, one derived it from Cadiz, by means 
of a Spaniard, named Sancho. Another from Malaga, by a 
different Spaniard, named Santos. Others designated indi- 
viduals, with different names, from these places, as having 
done the mischief. That some persons arrived, and sickened 
at Gibraltar, after having imbibed the noxious exhalation 
Cadiz, and Malaga, may be true, and, also, that this happen- 
ed about the time when miasmata, similar to those which had 
occasioned the epidemic in those cities, were beginning to op- 
erate at Gibraltar, may also be true : but this is all that can 
be said with truth. 

The accounts are almost as contradictory, in regard to the 
particular time and spot at which the first case or ca«*< 
this fever appeared in the town of Gibraltar. Thi> contra 
diction, which could not have happened, if the disease had 
originated from an imported contagion, would naturalh 
cur in regard to an epidemic arising from miasmata, which 
beginning to act, often at several places, and always in dit 

to the army Medical Board, for the re-consideration, I copied the following ex- 
tract, relating to Gibraltar, (which has also been noticed by Dr. Monro 
" Gibraltar, from the middle of November to the latter end t>f March, tin 
time for landing ,■ June, July, August, and September, the worst „• the garrison 
being very subject iu these months to bilious crul putrid fevers." 



327 

ferent persons, about the same time, and producing in them 
diseases of various degrees of violence, it must have been 
difficult, (as it has been found to be in New York, Phila- 
delphia, &c.) to draw a line of separation, between the com- 
mon bilious remittent, and that which, by being a little more 
severe, were mistaken for a new fever ; especially as these 
marsh epidemics commonly begin with the milder forms, 
and increase by almost insensible gradations. Hence some 
accounts represent the epidemic in question as having first 
appeared at Gibraltar about the tenth of August, and others, 
as having begun about the 8th or 10th of September, and 
this in different individuals, as well as places. 

It appears, however, that the fever began to attract par- 
ticular notice in several houses near the governor's parade, 
a little before the middle of September, and soOn appear- 
ed in so many others, that it was found utterly impossible, 
as might be expected, in an epidemic from such a cause, to 
trace any sort of connexion, in regard to its progress ; and 
though most of my' information has been obtained from gen- 
tlemen who had believed in the existence of contagion, yet 
that information warrants me in asserting, that no one fact 
has been substantiated, to prove that there was a single in- 
stance, in which the disease had been communicated from 
one individual to another: Indeed, it must have been dif- 
ficult, in a place so confined and crowded as Gibraltar was, 
to have distinguished between the effects of miasmata and 
those of contagion, otherwise than by the greater rapidity 
with which fevers, from the first of these causes, general- 
ly appear to spread within certain limits, as then happened 
at Gibraltar. But I do not find that any experiment was 
devised, Or pains taken, for the purpose of ascertaining the 
truth, had it been practicable, on this point. Dr. Nooth, 
an army physician, of great experience, as well as learning, 
who was then at the head of the medical department in 
Gibraltar, had, during his long services in different parts 
of America, become well acquainted with marsh fevers, in 



328 

then* several forms, and he was soon convinced that an 
exact similitude existed between the most violent of these, 
and the disease then prevalent at Gibraltar, and, consequent- 
ly, that the latter was void of contagion ; and, though per- 
sons less acquainted with these fevers, and, therefore, less 
qualified to decide respecting that of Gibraltar, very gene- 
rally, concluded the latter to be contagious ; and, probably, 
for no better reason than the fallacious one of its spread- 
ing epidemically, Dr. Nooth, as I am informed, did not 
see any cause to change his opinion on this subject. 

In regard to the symptoms of this fever, they were, in 
every respect, similar to those of the epidemics then and 
lately prevailing at Cadiz. Malaga, \c. and, therefore, all 
my observations on the latter will be applicable to the former. 
It began at the time when marsh fevers are commonly n 
prevalent, and was preceded by that intensely hot and dry 
weather, which renders them most violent, and which would 
have destroyed a typhus or contagious fever : and it was ex- 
tinguished like other marsh fevers, by the rains and cool 
weather of December, which would not have extinguished any 
contagious fever yet known : like the yellow and other marsh 
fevers, it attacked, with the groatcst violence and mortality, 
persons from cold climates ; and either did not affex 
fected but slightly, persons who had resided for a long time 
between the tropics, and had but lately quitted that residence. 
Thus it appears, by the official returns, that the 10th n 
lately arrived from the East Indies, by the way of Egypt, 
though 74S in number, besides commissioned officers, lost only 
twenty -eight men during the epidemic : and of these, the 
greater part were unseasoned recruits sent to Gibraltar from 
England : whilst, on the other hand, the regiment of De Roll, 
consisting principally of Germans, who had not previou 
served in any hot climate, lost 1ST out of 60S men : abase 
third of their number. The mortality was < on the 

2d of October, when nearly 150 died. After the 1st of N 
vember, it diminished greatly. 



329 

Strangers arriving at Gibraltar, while the fever prevailed 
were most commonly attacked with it on the 2d, 3d, or 4th 
day, after their arrival ; a space much too short for the opera-^ 
tion of typhus contagion. Mr. Pym, Surgeon to the garrison, 
and now Deputy Inspector of Hospitals, who had read and 
believed Dr. Chisholm's account of the alleged introduction of 
a new and highly contagious fever at Grenada, by the ship 
Hankey, imagined the epidemic at Gibraltar to resemble 
that fever; and he endeavoured, in a conversation with 
me, to explain how it might be distinguished from the or- 
dinary bilious fever of Gibraltar ; and this was by an ag- 
gravation of symptoms similar to that which Dr. Cbisholm 
has mentioned as having distinguished the supposed Hankey 
fever from the ordinary Yellow Fever of the West Indies. 
Expecting, as I do, to demonstrate, in my seventh appendix, 
that no fever, of any kind, was derived from the Hankey, and 
that no such contagious fever as is supposed, ever existed, it 
eannot be necessary that I should here discuss that subject. 

In the year 1810, a state of weather, similar to that of 1804, 
in regard to heat and drought, subsequently to a very wet 
spring, occurred at Gibraltar, Cadiz, Carthagena, &c. and 
re-produced the Yellow Fever at all these places ; but, as this 
state of weather began later, and lasted a shorter time, than 
in 1804, the disease was not, in many cases, so violent, nor 
did it prevail so extensively, or so long, as in that year. The 
worst cases at Gibraltar appeared in a few transports, upon 
their arrival from Carthagena, where their crews had been 
exposed to more virulent miasmata than those at Gibraltar.* 

* Most of these cases fell under the care of Mr. M 'Arthur, Assistant-Surgeon of 
the th Veteran Battalion, who, in giving an account of them, dated October 29, 
1810, writes as follows : " After carefully observing the symptoms and progress of 
the fever that lately raged here, and comparing it with the accounts of the malignant 
Yellow Fever that prevails in the West Indies, I am clearly of opinion, that it is ex- 
actly the same disease. In its symptoms and character, it almost accurately corres- 
ponded with the description of that disease given by Mosely. N B. Dr. Moseley's 
description was written long before the Hankey was built, and is generally well suited 
to the severer forms of the Yellow Fever in America. 

43 



330 

In the town o? Gibraltar, some persons died of the fever in 
three or four days, but many of the cases were milder, and so 
much like the ordinary bilious remittent, that some doubted 
whether it was similar to the fever on board the transports. 
Others imagined that there were two sorts of fevers in the 
town, one contagious, and introduced by some means or 
channels unknown, from the transports ; and the other, an 
indigenous, marsh, or bilious fever. Nearly the same varia- 
tion, in the degrees of violence, occurred in the fever at Cadiz, 
and would naturally occur to marsh fevers, and to no others 
in such a season. The following is translated from a decla- 
ration, dated Cadiz, November 2, 1810, and signed by Sir 
James Fellows, and nine Spanish physicians, viz. : 

u We, the undersigned physicians, having deliberated on 
the questions proposed to us by the Supreme Junta, relative 
to the nature and symptoms of the disease now prevalent, 
have agreed that it is the same in kind as that which raged 
here in 1800 and 1804, but that it is less frequently malignant 
and contagious ; we having observed, in many of the sick, 
disorder of a different character, which cause the reigning 
fever to be less intense and infection-." 

How a contagious fever, in one set of patients, should be- 
come less contagious and intense, because others had different 
disorders at the same time, I do not understand — probably 
these other disorders were remittent fevers, or Taberdillos. 
These Spanish physicians, however, seem to have become 
confident than formerly, in the supposed contagion of their 
epidemic ; and 1 am well informed, that but a day or two be- 
fore the date of this declaration, Sir James Fellows had de- 
cidedly expressed his belief, that it teas not contagious, though 
he formerly entertained a different opinion of the epidemics 
in Spain and at Gibraltar.* 

* Whether Sir James Fellow.s vould ever have entertained such an opinion of 
these epidemics, had he been lefv, by Dr. Haygarth and others, to the unbiassed con- 
clusions of his own reason, may, I think, be questioned. And I think k rigtrt to 
mention, as an instance of Dr. Haygarth's confidence in his own judgment, respect 



331 

Probably my readers will agree with me, that my view 01* 
this subject may now be closed with propriety. I might, in- 
deed, have taken into it hundreds of facts, in addition to 
those which have been recently noticed, and of similar import; 
but I think too highly of their understandings to suppose that 
such additions can be necessary. 

There are but few things more obscure or fallacious than 
the subject of febrile contagion. The matters, (whatever 
they may be) which produce contagious fever, being like 
marsh miasmata, imperceptible by our senses, and like them 
applied to the body through the medium of the atmosphere, 
we can never directly trace either of these morbific agents 
backward to its source, so as, by that means, to ascertain 
whether it had emanated from a person labouring under fever, 
or from the earth. Fortunately, however, the fevers, occa- 
sioned by these several causes, are distinguishable from each 
other by certain characteristic marks and peculiarities, with 
which, by long experience, and numerous observations, we 
have been made acquainted, and thereby enabled, with cer- 

ing a disease which he had never seen, (and of which his notions were most errone- 
ous) and of his solicitude that others should adopt and act exclusively upon his opin- 
ion, that, in a letter to a member of the late Army Medical Board, and dated De- 
cember 16, 1804, he wrote as follows, viz. : "Can you think it proper to leave up- 
on the medical staff, a single person who doubts whether this pestilence, (the fever 
at Gibraltar) and all the calamities which it has occasioned, were solely produced by 
contagion ? Every doubt of this kind will hinder the vigorous measures which will be 
required for the thorough cleansing all the houses, boxes, furniture, and clothes, 
from every particle of the infectious poison. Every hint suggested to discourage the 
necessity and utility of such purification, will destroy the salutary confidence whieh, 
in truth, ought universally to prevail." I hope, and, indeed, believe, that Dr. 
Nooth's retirement from active service was with him a matter of choice, and not an 
effect of this letter ; but I must think that Dr. Haygarth ought at least, to have 
had some personal knowledge of the disease in que stion, and of the facts connected 
with its origin, before he attempted, on that ground, to deprive the public of the ser- 
vices of gentlemen who did possess that knoxvledge, together with as much intellect 
as himself, and who were therefore, better qualified and entitled to form opinions on 
the subject. I certainly do not impute to Dr. Haygarth any other than benevolent 
intentions in this exercise of his zeal ; for I believe such intentions have often actua- 
ted the most violent zealots, whilst persecuting others, even to death, to compel their 
assent to articles of faith. 



332 

tainty, to refer each of these fevers to its separate cause. We 
are, moreover, often enabled, in some degree, to ascertain, 
by a proper attention to facts, which of these different causes, 
or rather which of their sources, has been sufficiently ap- 
proached by an individual or individuals, for the production of 
disease ; and thus to discover the father, by the features of the 
child, and by the exclusive opportunities of access which the 
father has enjoyed. 

My readers will recollect, that all these means have bce» 
employed by me in regard to the yellow, and its kindred marsh 
fevers, especially in the view which has been just closed, In 
which it has been clearly seen, that they are all the offspring 
of one parent ; and a solid foundation has been thus acquired 
for presuming, that the yellow, like other marsh, fevers i- 
void of any contagious quality.* It has also been seen that, 
in many thousands of instances, the Yellow Fever has clearly 
manifested and proved itself tobe completely destitute of conttu 

* Those who have imagined that marsh fevers might become contagious, have, 
prohably, never reflected upon the monstrous effects which, in that case, would ne- 
cessarily have ensued. If the small-pox, measles, &c. had not been rendered con- 
tagious, these diseases would have existed only in the persons Jirst attached by 
them and the purposes, which Ihey wore intended to fulfil among mankind, must 
have failed. But the cause of marsh fevers exists to such an extent, and so perma- 
nently, that, probably, the loss of human life occasioned by it, without any aid from 
contagion, exceeds that of all other diseases incident to mankind : and if fevers pro- 
duced by marsh miasmata could acquire a contagious power, and thereby produce 
other fevers, in addition to those which their original cause will, doubtless, continue 
to produce abundantly, and •without eiul, such enormous additions, to the widelv- 
extended and powerful mischiefs of marsh miasmata, would long since, in the ordi- 
nary course of things, have exterminated the human race. For the coldest habitable 
regions would not, in that case, have afforded an asylum to mankind, as tliev now 
do, from the evils of marsh miasmata. Because that monstrous production of I 
from the contagion of marsh fezvr, would be enabled to reproduc 
tagious fever, even in Lapland. And of what description can we i 
fever would be ? Does any one conceive that a fever, resulting immediately from the 
action of marsh miasmata, would resemble one produced by a different cau<k . 
the contagious quality which had been acquired by a marsh fei*?r ? This, and many 
other absurdities, might have been avoided, by attending to one great fundamental 
truth ; viz. that no disease is ever contagious, unless it has orig-i noted from contqgim. 
And that contag-ious diseases can onhj be produced by thei" respective cwUoy»«w. 



333 

And, as truth is invariable, and the same disease, in suitable 
circumstances, is always or never contagious, we may safely re- 
ly on this immense mass of evidence, and conclude, that the few 
instances of a contrary appearance, (and there are but very few 
which have not already been shewn to be founded in error or 
misrepresentation) were observed and reported imperfectly, 
or under the influence of prejudice, or deception.* This con- 
clusion will, I hope, produce important benefits to mankind, 
notwithstanding the outrageous criminations by which Dr. 
Chisholm has endeavoured to obstruct all free inquiry, and 
frighten or overwhelm his opponents on this subject. (Letter 
to Haygarth, p. 159.) Great as the evils may be, of mis- 
taking a contagious for a non-contagious disease, those pro- 
duced by the opposite error, are, at least, of equal magni- 
tude : though, under the influence of terror, the former have 
been seen with microscopic eyes, and the latter, in a great 
degree, overlooked. 

Without ( insisting npon those expensive delays and embar- 
rassments, by which useless quarantine laws shackle the com- 
merce, and naval operations of a great maritime country, I 

• l have already given instances of very erroneous inferences in favour of the sup- 
posed contagion of Yellow Fever, from facts which, rightly understood, were capa- 
ble of proving it to be rao?i-contagious. The following is an instance of such an 
inference, from a fact which at the utmost, is but equivocal, viz. Dr. Dancer, of 
Jamaica, in a note to his " Observations on the Contagiousness and Importation of 
Yellow Fever, in the New York Medical Repository, vol. 7, p. 253," says, " agree- 
ably to the information I have received, from several country practitioners, the 
crews of ships stationed at the out-ports are generally healthy until one or more 
persons fall sick." A truism which seems applicable to ships at the in-ports also. 
He adds, " but, as soon as a single instance of Yellow Fever occurs, the disease 
spreads from one person to another, till it goes through the whole ship, and after- 
wards from ship to ship." But this, which Dr. Dancer mistakes for a proof of conta- 
gion, is only, what might be expected from miasmata, among ships lying within 
their reach. From various circumstances, their morbid effects appear sooner in 
some persons and situations than in others. Some will, therefore sicken earlier 
and others later ; and Dr. Dancer's mistake consists in supposing that the person 
who first was attacked, gave the fever to the second, &c. while, in fact, they all 
drived it from one common source. The like mistake has been made by many 
others; and even by Dr. Lind, at p. 184, 5, of his work on Preserving Health in 
Hot Climate* 



334 

may ask, if it be an harmless error which misleads mankind 
respecting the cause of an epidemic, and not only induces 
them to employ vexatious precautions to guard against imagi- 
nary dangers, but also to neglect the only proper means of 
future preservation, by meliorating the condition of the 
places they inhabit ? Dr. John Hunter has well observed 
that, " by supposing a fever produced by marsh effluvia to 
be the effect of contagion, an army may be left to perish, in 
an unwholesome situation, which might have been saved by 
removing to one where such effluvia did not exist." (Dis- 
eases of the Army, p. 320.*) And it is notorious that, dur- 
ing the late epidemics in the soutli of Spain, an unfortunate 
exercise of civil authority, occasioned the loss of many thou- 
sands of lives, by compelling the inhabitants of the towns. 

* It is not always in the power of a general to choose or change his situation 
pecially when his army is weaker than that of the enemy. Hut when this is the 
case, there is good reason to believe that the morbid effects of marsh miasmata may, 
in a very considerable degree, be obviated, by administering the Peruvian bark, with 
apsicum, or ginger, allspice, and bitters, copiously to those who are in apparent 
health- In September, 1809, when an application was made to me by the Surgeon- 
General, with the sanction of his Majesty's ministers, to join Dr. Blane in the mission 
then proposed for Walcheren, I fully intended, if possible, to procure a fair trial of 
these prophylactic means, upon the British troops there. And when f was hin- 
dered from joining in that mission, by causes which it would be improper to men- 
tion here, I communicated my ideas and wishes on this subject to the Secretary of 
State for the War Department ; in which, however, a change was then taking place; 
and from that, or some other cause, my communication remained without effect. It 
would have been my desire that each soldier should take night and morning a drachm 
of the bark in powder, with half as much of powdered ginger, or allspice, or an 
equivalent portion of capsicum, in a moderate glass of rum, brandy, or gin, or half a 
pint of porter, for the space of a fortnight; and this I would have repeated, after 
the interval of a week, again and again, till the beginning of December, when the 
noxious influence of marsh effluvia would have ceased to operate, until the month 
of May, and then I would have recommenced a similar course, but with smaller 
doses of the bark, &c. which would, I think, have been sufficient, if begun so early 
in the year. By such means I certainly should have expected to save many lives, 
and obviate the necessity of abandoning that island. And this expectation would 
have been founded upon several facts published by Dr. Lind, Dr. Robertson, M. At* 
phonse Le Roi, &c. and upon others not published, which have either occurred 
within my own knowledge, or been communicated to me, upon unquestionable 
authority. 



335 

where it prevailed, to remain in their morbific atmosphere, 
lest, by quitting it, they should infect others. 

These, however, are but part of the evils resulting from a 
dread of contagion, where it has no existence. Few in this 
country have heard or can conceive how often, and to what 
an extent, the strongest and best ties which unite and benefit 
mankind, have been cruelly broken, within the last twenty 
years, in some parts of America and Spain, by persons act- 
ing under the terror of imaginary dangers; and driven by 
it, to abandon their homes, their occupations, and even their 
nearest relatives and dearest friends, in the hour of sickness ; 
and, by this desertion of the duties of humanity, this denial of 
that assistance, and those consolations which might have 
been afforded, without the smallest danger, to render these 
visitations of disease incalculably more afflicting and fatal 
than they otherwise would have been. Don R. Amesto, in 
the work heretofore mentioned, asserts that the barbarous and 
anti-social belief of the importation and contagion of Yellow 
Fever, has, from its baneful influence in Spain, caused many 
unfortunate victims to be abandoned, and left to starve in their 
beds. That others have been shot at the very doors of houses 
in which they endeavoured to find an asylum ; and that many 
others were carried alive to their graves." Let the zealots, 
who have contributed to this monstrous inhumanity, reflect 
upon it, and if their intentions have, as I hope, been good, 
let them, at least, maturely examine and re-consider the 
foundations of their belief, before they again endeavour to 
carry it into action. It neither requires, nor indicates even a 
mediocrity of understanding, or learning, to adop tthe com- 
mon notion of contagion and foreign derivation, in regard to 
epidemics; nor does the facility, with which these notions 
are propagated, afford the smallest presumption in their fa- 
vour. By much the greater part of mankind do not possess 
either sufficient industry or knowledge for the due examina- 
tion of a subject so intricate, and complicated, nor have they 
so much of the power and habit of close, and accurate, rea- 



S36 

soning, as is necessary to decide respecting it. Every one, 
however, can believe, and the belief of contagion affords a 
ready solution of all difficulties, without the trouble of in- 
quiry or even of thought ; and we need not, therefore, won- 
der that contagion, like witchcraft, should have been univer- 
sally believed, (though as little understood) and often with as 
little foundation. 



END Or FART IV. ANI> OF THE ESSAY ON YELLOW FEVER. 



PART FIFTH. 



CHAP. I. 



i 

OBSERVATIONS ON TYPHUS, OR CONTAGIOUS FEVER* 

Though the Greek noun Tv<po$ (stupor*) was applied by Hip- 
pocrates to several diseases, all of them very unlike the fever 
in question, (which probably was unknown in Greece,) I 
shall not object to the name, as distinguishing those fevers 
which accord with Dr. Cullen's definition of this genus.* 
But I think there is great reason to object to the vague and 
loose application of it, which is now become frequent, to 
designate generally all low or slow fevers, arising from great 
fatigue, cold, and damp habitations, unwholesome, or insuf- 
ficient food, anxiety, grief, fear, and other depressing pas- 
sions, and debilitating causes, which have no connexion with 
contagion, nor amj power of 'producing a contagious disease. 
I believe in the existence of a fever, sui generis 9 strictly con- 
tagious, (unconnected with any of the exanthematous dis- 
eases.) and, therefore, according to my view of the subject, 
derived exclusively from its own specif c cause, or contagion. 
In this, which I consider as the only contagious fever, there 
are, I think, some varieties ; but without any differences 
sufficient to form more than one species. — The facts and 



* Cullen. Gen. Morb. p. 71. " Typhus morbus contagiosis ; calor parum auctus ; 
pulsus parvus, debilis, plorumque frequens ; urioam parum matata ; sensorii ftinc- 
tiones plurimum turbatte ; vires multum imminutje." 
43 



338 

reasons which have led me to this belief, will have heen seen 
in the second part of this volume, at p. 89, and seq. and 
they are sufficient, in my judgment, to outweigh all the 
great authorites to which they are opposed, and render it 
absolutely incredible that any inanimate matters, even those 
excreted by living animals, should by any natural, or artifi- 
cial decomposition and recomposition, ever require a power 
strictly contagious, or iu other words, be enabled, like living 
animals and vegetables, to assimilate other matters to their 
own nature, and thus multiply and perpetuate their existence* 
Some writers of considerable reputation, sensible, perhaps, 
of this difficulty, have made a distinction between contagion 
and infection, and have ascribed the production of typhus 
fever, and some other diseases, to the latter. One of these 
writers, Dr. Adams, (in the quarto edition of his Observa- 
tions on Morbid Poisons, at p. 6,) after adopting this dis- 
tinction, says of "infectious diseases," that they "do not 
require for their production matter similar to their effects, 
but may at any time be generated, by crowding together the 
sick or wounded, of any description."* He then mentions 



* Scores ofjustly distinguishedfauthors have roade simihir assertions, without any 
decisive tact or evidence in support of them, so tar as I can discover ; probably rely- 
ing on the authority of those who had written antecedently. Had this assertion 
been true, the sick and wounded at Walcheren ought to have produced at least as 
many cases of typhus fever, as hat! previously occurred in the same year, among the 
British troops at Corrunna, by actual contagion. The sick, at least, if not the 
wounded, at the former place, having been more numerous, and in many cases more 
crowded. But, contrary to genera! expectation, not a single instance of typhus fever 
appears to have been thereby occasioned. That such a production of typhus fever 
might have been expected, according to the common opinions, will appear from a 
letter written to the Deputy Secretary at war, by the Physician General, Sir Lh- 
cas Pepys, (after he had visited the hospitals in the Eastern District,) dated, " -\rmv 
Medical Board Office, Septemher 14, 1809." in which he >ays, «■ the disease afflicting 
the troops returned from Holland, is the bilious remittent, and intermittent fever 
liable to degenerate into typhus and contagious fever ; but it has not, so tar as I have 
witnessed, thai character at present, nor is there any dysentery. " See Military Pa- 
pers, letter K. p. 52. 

Other eminent physicians have not only believed this liability of marsh fever to 
degenerate into contagious fever, but imagined that such degeneration had actually 



339 

44 hospital, prison, or ship fever, camp dysentery, and some 
peculiarly malignant ulcers," as heing infectious diseases; 
adding, that " though these diseases when formed, may 'pro- 
duce their like effects in others, yet we can always trace their 



begun to take place. Thus Dr. Blane, in his letter to the Physician General, dated 
Middleburgj October j, 1809, says " the fever known by the name of typhus, with 
which armies in ordinary circumstances are chiefly affected, has been rare,"— ~" as 
yet, among the troops here I am sorry to say, however, that both diseases begin to 
shew themselves, particularly at Flushing, where the accommodation is far inferior 
to that at Middleburg." Military Papers, E. p. 103. And in another letter, dated 
the 6th, he explains the causes which render the situation of the sick at Flushing 
" much worse ;" adding, " they are also over crowded and dirty." E. p. 98. After- 
wards, in a joint letter from Dr. Blane, Dr. Lempriere, &c. to the Seeretary at War, 
dated October the 10th, 1809, we find this observation, viz. " The malady is not 
contagious in itself, but liable to assume that new form of fever, wherever ventilation 
is defective, the patients crowded, or where other local causes of impurity prevail.— 
This has been strikingly proved in some instances, particularly at Flushing, where 
we found the accommodations too confined and crowded." E. p. 107. That these 
gentleman in this instance mistook a few cases of low, or slow nervous fever, for a 
contagious or typhus fever, (as has been done thousands of times,) was manifested af- 
terwards, by the facts stated at p. 215 — 19 of this volume. And certainly if the gen- 
eration of contagious fever in the way, and by the raeans in question, had been pos- 
sible, the supposed instances of it would not have been confined to Flushing ; other 
places having been very sufficiently crowded, as is proved by a letter from the gener- 
al in chief, Sir Eyre Coote, to Lord Castlereagh, written on the 17th September, 
1809, immediately after a personal inspection of the different regimental, as well as 
general hospitals. " Middleburg, (says he,) from the size of its building, affords the 
best accommodations, but even in tliat town the sick are so crowded, as to lay (lie) 
two in one bed, in several places, and have no circulation of air." — " At Veer, a large 
church contains about 400 patients, the other places are miserably small, and exces- 
sively crowded At Armuyden the accommodation for the numerozis sick is wretch- 
ed. " 

I have admitted at the begining of this note, that the number of wounded men at 
Walcheren, was greatly disproportion ed to that of the sick. But there is suf- 
ficient evidence to prove, notwithstanding all that has been written and believed to 
the contrary, that patients of the former description do not generate contagious 
fever any more than the latter. Dr. Blane, who was physician to the fleet under 
Lord Rodney, mentions that the battle of the 12th of April, produced an addition of 
810 men to the list of wounded. But though the whole fleet was detained at sea 
until about the end of that month, and the last division of it did not reach Port 
Royal, in Jamaica, until the 25th of May, and though the discharges from so many 
severe wounds, must in that climate have become highly fcetid, " yet" says Dr. 
Blane, (p- 76) (f fhr.c wns less sickness and less death from disease in this month 



340 

origin in causes different from their effects.* 9 That Dr. 
Adams, who is accustomed and qualified to reason, should 
have believed any thing so unphilosophical, and incongruous* 
would have been incomprehensible to me, if so many others 
had not discarded common sense on the subject of contagion. 
To represent a disease which is notoriously contagious, and 
propagated by contagion, as capable of being also produced 
by other, and those very different means, is to multiply causes 
unnecessarily, and, therefore, unjustifiably ; and it moreover 
destroys the natural, and just influence of causes upon their 
effects, by making the same disease result from very dissimi- 
lar causes. In this way, the infectious diseases of Dr. 
Adams are supposed to acquire all that is wonderful in conta- 
gion, I mean the power of reproducing, and perpetuating 
themselves, without deriving any thing from that original 
product of divine wisdom and power, to which I am forced 
to refer the beginning of all strictly contagious diseases ; 
and while thus enabled to multiply themselves, ad infinitum, 
similar diseases with the same reproductive powers, are 
supposed to originate from time to time, in thousands of 
other persons, without any legitimate or suitable cause, or, 
in the language of Dr. Adams, by the agency of matter, 
dissimilar to its effects : and these monstrous products, of an 
equivocal incomprehensible generation, are to be considered 
as similar in their natures and effects, to those resulting from 
specific contagions. Were it possible for typhus thus fre- 



( April), than in any of the former 23 months, in which I kept records of the fleet, 
and less than in any subsequent month, till the fleet got to the coast of America." 
And that au accumulation of wounded men is no more productive of fevers of any 
kind in cold weather, than in hot, as just mentioned, I need only copy what Dr. Lind 
has stated at p. 213 of his work on the Health of Seamen, concerning the *llagna- 
nime, ship of the line, viz. " She was seventeen weeks at sea, and for a whole 
month of that time, during very bad and stormy weather, had on board the men 
■wounded in the general engagement on the 20th of Xoveml>er : notwithstanding 
this long continuance at sea, ar.d the violent storms she encountered, yet of 70Q 
men, 5 persons ouly were reported to us to be sick, besides the wounded, and these 
chiefly in chronic disorders.*' 



341 

quently, and easily, to originate without contagion, and at 
the same time acquire and multiply itself, by a Contagious 
quality, who could ever hope to escape that disease ? 

If Dr. Adams had supposed typhus fever to be not conta- 
gious, his opinion that it might be produced by a great accu- 
mulation of sick and wounded, in close or ill ventilated 
places, would not to me appear, a priori, improbable ; as 
the atmosphere may become unwholesome, either by not con- 
taining a sufficient portion of the vital part of it, or by the 
addition of noxious vapours dispersed therein ; and it might 
be very naturally expected that fever would occur among the 
disorders resulting from such a deficiency of oxygenous gaz 
on one hand, or such noxious additions on the other ; though 
we are not entitled to believe that this really does happen, 
without some evidence of the fact, and of this (as has been 
observed at p. 89 and seq.) there is none within my know- 
ledge, excepting that which relates to fevers produced by 
exhalations from the earth, and excepting that connected with 
specific contagions. 

Though contagious fever has probably existed for many 
ages in this, and some other northern countries, its history is 
involved in great obscurity, because it was not, until very 
lately, observed and distinguished with any tolerable accu- 
racy.* Even Sydenham did not consider this fever as pro- 

• 

* One of the most early and unequivocal accounts of typhus which I have met 
with, is in the first volume of the "Acta Medicorum Berolinknsium," of which I 
have the 2nd edition, printed at Berlin, in 1719. The first article, the title of 
which is "Anni prseter lapsi, 1716, Status epidemicus speciatim historia febrium 
petechialium, tunc temporis grassantium," containing an account of a contagious 
petechial fever prevalent " in Pomerania citeriore," p. 10 " Ultra flavium Pene, 
Grypswalda?, Stralsundse atque in insula Rugia, (Rugen) magnus incolarum nu- 
merus, hac maligna febre afihctus fuit. Regnavit dirum hoe contagium per totam 
fere hyemem anni prseterlapsi 1715, ultimumque suura non ante effudit impetum 
quam sequinoctium vernale, anni 1716 superaverat, solstitiumque cestivale plenhis 
attigerat?'' This account, or, as it is called " Methodus, Jktheses practicsc, secun- 
dum quas febres accutse petechiales, anno, 1715, post solstitium hyemale & dein 
porro in nosocomiis castrensibus & alibi tractatse fuerunt," was written by the Ar~ 
chiater regius ; and to these, " nonnihil desuis quoque addidit, Doctor Schwartzius." 
It is stated at p. 18, that both these physicians died of this fever j the treatment 



342 

ceeding from contagion, but as depending on a particular 
state, or constitution of the atmosphere. Huxham and Prin- 
gle, as I have formerly mentioned, were the first who gave us 
distinct and just notions of contagious fever, though Dr. 
Ebenezer Gilchrist, of Dumfries, had previously written two 
papers on it, under the name of " Nervous Fever," one in the 
fourth volume of the Edinburgh Medical Essays and Obser- 
vations, printed in 1737 ; and the other in the fifth volume of 
that work, printed in 1744. And though he was silent con- 
cerning its contagious nature, his descriptions, separated from 
the theoretical reasonings adapted to his time, are generally 
correct. He states " this fever to be very different in its na- 
ture and changes, from other fevers," and to have "some- 
thing peculiar in it which neither the ancients nor moderns per- 
haps had described, if at all thought of." Vol. 5, p. 507. He 
adds, at the next page, " as our fever seems to be peculiar to 
this age, it is not a little surprising that much more had not 
been said upon it. Some scattered 1 ints are to be found in 
late authors, both just and ingenious, but not sufficient to make 
out a system of the disease." He did not, however, mean to 
represent this as a new disease, because in the preceding vo- 
lume, at p. 348, he had stated it to have "been these many 
years fatal in Britain" He appears to have treated the fever 
judiciously, and to have formed just opinions of the effects of 
opium, bark, andfwine, in certain circumstances. 

Typhus is properly the disease of cold climates, and in this, 
as in almost every other particular, it is in direct opposition 
to the yellow fever. The late Dr. John Hunter, in a paper on 
the gaol, or hospital fever, (Medical Transactions, vol. 3, p. 
348,) says, " I have never seen the fever earlier than the month 



which they chose for themselves, is also mentioned ; and, it is not surprising, that 
bleeding and emetics, repeated at advanced stages of the disease, should liave 
brought on hiccuping and petechia, and have occasioned death. 

The description of the symptoms, and of the effects of some of the remedws 
employed, which will be chiefly found between pages 10 and 25, are Judicious, and 
afford" unquestionable proof of the existence of this fever in the army, and lower 
classes of the people, iu certain parts of Pomerania. 



343 

of November, and I believe it seldom appears so soon. It be- 
comes frequent about Christmas, and increases during the 
months of January and February. If March and April are 
warm, it grows less frequent : but if they are cold, it con- 
tinues nearly as common as in the preceding months, which 
was the case in the two last winters, both of which were unu- 
sually cold. When the weather begins to grow warm, it gra- 
dually disappears." P. 350. He adds, (p. 366,) " I would,) 
observe, that for upwards of two years, that I remained in Ja- 
maica, I never saw one instance of the hospital fever, though 
the military hospitals were often as much crowded as they are 
in Europe." "The heat proves a prevention of the disease, 
as much as cold forwards its production."* 

The influence of heat in mitigating, and finally extinguish- 
ing contagious fever, was very fully manifested in regard to 
the troops which sailed from Cork, under the command of 

* Numerous facts might be mentioned in confirmation of this general assertion. Mr. 
Howard has repeatedly noticed the greater prevalence of jail fever, during winter, 
than in summer; and Dr. Trotter, in the first volume of his Medicina Nautica, p. 
197, observes that '* as cold weather, and a winter season, favour the action of ty- 
phus infection, we know that warm weather, and a summer season, assist in its extinc- 
tion." And of this he gives several decisive instances and proofs. Dr. Blane had 
previously made a similar observation, at p. 233 of his work on the Diseases of Seamen, 
Dr. Lind also has mentioned facts, in which heat produced similar effects, though he 
appears not to have understood the cause; at p. 319 of his volume on Preserving 
the Health of Seamen, he observes, that "this infection (of typhus fever), after every 
method used to destroy it lias proved ineffectual, will often of itself, gradually abate, 
and at length entirely vanish." This he adds, " I often observed in our prisons, during 
the last war, where, after committing great ravages among the French prisoners, 
the infection often stopped of a sudden, and they were sometimes so entirely free 
from it, that in the month of September, 1762, when I was employed by the govern- 
ment, to muster the prisoners of war in the castles of Porchester and Winchester, 
which in the preceding year had suffered much by the jail distemper, I did not find 
one person labouring under that distemper, among 7000 prison el's, many of whom had 
been confined for several years." (See Lind on the Health of Seamen, p. 320, 321.) 
Here there is good reason from the month f September J in which this entire cessation 
of the disease was found to have taken place, to conclude that it had been produced 
by the heat, of the preceding summer months, though Dr. Lind assigns no cause for it 
which seems indeed to have been an extraordinary oversight and omission, especially 
as at p. 233 of the same volume, he had inferred from several facts, «« that a cold damp 
air increases the power and vigour of contagion ;" meaning that of typhus fever. 



344 



major-general White, for St. Domingo, in February* 1796* 
Two hospital ships, in which I had embarked, and sailed from 
England with the army, under sir Ralph Abercrombie, hav- 
ing by storms been rendered unable to continue the voyage, 
and the last of them having landed me on the south-west coast 
of Ire, I embarked on board a very large hospital-ship, the 
Bridgewater, (formerly an Indiaman,) destined to receive the 
sick of general White's division, among which a severe typhus 
fever had prevailed to a great extent, and with great morta- 
lity, previous to our sailing from Cork, where most of the sick 
were left at our departure ; but many of the -soldiers, appa- 
rently well, being exposed to the contagion which existed in 
many of the transports, or having imbibed it previously, 
whilst detained at Cork, fell sick on the passage, and were 
from time to time removed into the Bridgewater, which soon 
became full of patients, under typhus fever, which was com- 
municated to several of the orderly men, and nurses, to some 
of whom it proved fatal. It became evident, however, that as 
we reached, and proceeded in the warmer latitudes, the cases 
of fever gradually diminished in number, and became much 
milder ; though, from the shortness of our passage, and the 
cool season in which it was made, the full effect of heat in ex- 
tinguishing contagious fever, could not have been produced, 
and, therefore, it was not surprising that a few patients with 
the same fever, in a milder form, and apparently divested of 
its contagious power, were sent on shore to the hospitals, im- 
mediately after our arrival at Barbadoes. These had proba- 
bly imbibed the contagion before our arrival within the tro- 
pics, and its effects, though moderated, were not wholly pre- 
vented by a change of temperature. One of the last persons 
attacked, was my own servant, who had indeed been suffi- 
ciently exposed to the contagion on board the Bridgewater. 
But in his case, as well as in all the others which occurred be- 
tween the tropics, the fever was slight, and not being commu- 
nicated in any instance, at least after our arrival at Barba- 
does, it there terminated. 



345 

In voyages to the East Indies, ships remain for a much 
longer space of time between the tropics, and being also ex- 
posed to an higher temperature, the power of heat in destroy- 
ing typhus fever, is in them more decisively manifested ; an 
entire cessation of the disease, (however prevalent) commonly 
taking place before they can reach the Cape of Good Hope. It 
has indeed never been known, as I am informed, that a single 
case of this fever had occurred on either side of the Indian 
peninsula. 

But without going from home, or farther back than the 
year 1809, we may find strong evidence of the power even of 
the moderate summer heat of our climate, in extinguishing ty- 
phus fever. It is well known that the contagion of this dis- 
ease, had been imbibed by many of the soldiers who returned 
from Corunna, in the beginning of that year ; who, being at- 
tacked either on board of the transports, or soon after landing 
in this country, the disease was communicated to nearly 10,000 
persons belonging to the army, (including those in the artillery 
and ordnance departments,) and this within little more than 
two months. I had a short time before obtained leave to re- 
tire on half-pay ; but finding that there was no army physician 
in the western district, I offered my services there, and ob- 
tained by doing so, an opportunity of observing the influence 
even of our vernal warmth, in mitigating and checking the 
fever, which ceased I believe completely, at least in regard to 
new cases, before the end of May, and even sooner in the 
western and warmer districts. 

"Whether heat interrupts or suspends the influence of typhus 
contagion, by dissipating the corpuscles, of which it consists^ 
or by rendering the body less susceptible of their impressions, 
or both, I will not venture to decide ; but certainly, those who 
by birth and residence, have been long habituated to inter- 
tropical climates, are, when they remove into the cold, parti- 
cularly susceptible of the action of typhus contagion, if ex- 
posed to it 5 and this has been found to be the case of Negroes, 
to a remarkable degree, particularly in the New England 

44 



346 

states, and in Nova Scotia, where the people of that race, 
who were exported at different times to Sierra Leone, had 
been very extensively attacked with contagious fever; and 
indeed many of them were ill, and some died of it, in their 
passage to Africa 5 but in all cases it was very soon extin- 
guished after their arrival at Sierra Leone, if not previously. 
Dr. Trotter has observed, at p. 205, of the first volume of his 
Medicina Nautica, that the natives of Africa " are very 
liable" to the fever in question ; adding, that " in ships they 
are commonly the first sufferers." So that in this respect 
also, the yellow and typhus fevers are directly the reverse of 
each other ; as they are moreover in the following particulars, 
viz. Typhus is aggravated by that degree of cold which ex- 
tinguishes yellow fever. It never prevails epidemically. It 
commences much less violently than yellow fever, and is pro- 
tracted to a greater length. It manifests no disposition to 
remit, unless the patient has imbibed marsh miasms, whilst 
even in the violent forms of yellow fever, there is generally 
about the 3d or 4th days, a very sensible, and often a very 
delusive cessation or abatement of the febrile commotion, and 
of all the inflammatory symptoms. In both, however, it is of 
high importance towards the cure, that the patients should be 
removed to, or kept in a pure wholesome atmosphere. 

In regard to their effects on the human body, Typhus is 
generally accompanied with less mortality, and the derange- 
ment which it occasions in the system, is much less permanent 
and mischievous, than that which accompanies or results from 
even the remittent fever of Europe. — Witness the events pro- 
duced by the former disease in the British Army, subsequent- 
ly to the return of the troops from Corunna, in 1809, and 
those which attended, or followed the expedition to Zealand, 
in the same year. In regard to the former, it appears that 
the deaths did not exceed one in ten of the sick, though the 
accommodations were in many situations but ill suited to that 
disease ; and a considerable number of the medical persons 
employed by Mr. Knight, were but ill qualified to direct the 



347 

treatment of the sick ; the whole were, moreover, restricted 
by his parsimonious regimental hospital system, from direct- 
ing those allowances, and indigencies, in regard to nourish- 
ment, wine, porter, &c. which are highly important to patients 
under Typhus fever. On the Zealand expedition, however, 
and without these advantages, the deaths were but a small 
fraction less than one in eight, the recoveries were much more 
tedious, relapses, perhaps, one hundred times more frequent, 
and very often followed by permanent obstructions, or morbid 
alterations of the Viscera, ending in Dropsy, or other chroni- 
cal affections ; which rarely occurred as the consequence of 
Typhus, in the troops from Spain ; who were in general fit 
for duty in six or eight weeks after becoming convalescent, 
which was never the case with those from Walcheren. 

Whilst I was employed with the troops from Spain labour- 
ing under Typhus, I thought it very desirable that so good an 
opportunity of ascertaining the time which the contagion 
thereof may remain latent after its application to the human 
body, should not be lost, as so many other opportunities had 
been ; and I therefore obtained, chiefly through the kindness 
of Mr. Grant, deputy inspector of Hospitals in the Western 
district, returns of the orderlies and nurses who had attended 
the sick in question, and had been afterwards attacked with 
the same fever ; and also an account of the time when the 
attendance of each began, and of the interval which succeeded 
previous to the attack. I found, however, that it was neces- 
sary in these returns to make a distinction between the order- 
lies and nurses, who had returned in the transports from Co- 
runna, and, consequently, had, at least in some instances, been 
exposed to the contagion, previous to their attendance on the 
sick here, (as was proved by the different results in these 
cases, from those of the persons who had not left England.) 
And, accordingly, this distinction was made in most of the 
returns. In all of them, however, there was an omission of 
the persons who had only been temporarily employed ; though 



348 



their number exceeded that of the regular orderlies and 
nurses ; but in regard to their cases it was difficult to ascer- 
tain dates. 

Having selected such of these returns as appeared to be 
most correct and suitable, I found that they produced the 
following results; — viz. of thirty-five orderlies and nurses 
who had returned from Spain, and, therefore, might have 
been previously exposed to contagion, it appeared that one 
was attacked on the first day after beginning to attend the 
sick; one on the 2d, one on the 6th, two on the 7th, one on 
the 8th, one on the 9th, two on the 11th, one on the 14th, 
one on the 15th, one on the 16th, three on the 17th, one on 
the 18th, two on the 20th, one on the 21st, one on the 22d. 
two on the 23d, two on the 24th, two on the 25th, one on the 
26th, three on the 27th, one on the 28th, one on the 36th, 
one on the 38th, one on the 40th, and one on the 44 th days. 
Of ninety-nine orderlies and nurses who had not been out of 
the kingdom, nor, as far as was known, exposed to febrile 
contagion, it appears that one was attacked on the 13th day, 
one on the 14th, two on the 15th, one on the 16th, four on 
the 18th, two on the 19th, three on the 20th, six on the 21st, 
four on the 22d, four on the 23d, two on the 24th, six on the 
25th, four on the 26th, four on the 27th, eight on the 28th, 
five on the 29th, three on the 30th, three on the 31st, two on 
the 33d, three on the 36th, four on the 37th, one on the 38th, 
four on the 39th, one on the 40th, two on the 4 2d, three on 
the 44th, one on the 45th, five on the 47th, one on the 48th, 
three on the 52d, two on the 54th, one on the 58th, one on 
the 60th, and one the 68th days. It results, therefore, from 
this statement, that among the ninety-nine orderlies and nur- 
ses, who had probably not been exposed to the contagion be- 
fore their attendance on the sick commenced, the earliest 
attack was on the 13th day, and the latest on the 68th : but 
these returns were made up about the 20th of April, and it 
appears that some who had escaped till that time, were after- 



349 

wards attacked 5* and, therefore, though there may be rea- 
son to conclude that febrile contagion does not remain inactive 
so long after being received into the body, as marsh miasma- 
ta, I see none for believing that an interval of five or six 
months, may not sometimes elapse before the actual produc- 
tion of fever by it ; especially if the summer should intervene 
previous to an attack ; in which case the occurrence of fever 
would, I think, almost always be postponed until the following 
winter, and often completely obviated :f and I cannot help 
strongly suspecting, that such a postponing of the disease hap- 
pened to some of the troops from Corunna, in 1809. It will be 
recollected that sickness prevailed to a very uncommon extent 
in the army at home, during the early part of the preceding 
year ; and though it did not consist exclusively of contagious 
fever, that disease made a considerable part of it, until it became 
extinct at the approach of summer. It will also be recollected* 
that many of the regiments in whom this sickness occurred, 
were, after its cessation, employed under Sir John Moore, 
and Sir David Baird, in Spain, where Typhus fever cannot 
exist in the Summer, and where, I believe, it never appears 
even in Winter, unless by an extraordinary introduction of 
it. Such an introduction took place in that year by the Spa- 
nish army under the Marquis de Romana, which had been 
removed from Holstein and Denmark, (where Typhus is a 

* Many circumstances or causes may accelerate the actual production of Typhus 
fever in persons who have imbibed a sufficient portion of the contagion ; particularly 
the effects of Cold, Drunkenness, excessive Venery, deficient nourishment, and in- 
deed of every thing occasioning debility, especially, in slender, feeble constitutions, 
in which the disease will also commonly prove most severe : and hence, contrary to 
what happens with Yellow Fever, those who are in the decline of life suffer more 
from it than the young, and females more than males. On the other hand, a robust 
young man, who after exposure to febrile contagion, prudently avoids all debilitating 
accideuts, or excesses, may, by the strength of his constitution, and of its conserva- 
tory energies, not only resist for a long time, but finally overcome, such a portion of 
infection as in most cases would have soon occasioned disease. 

f In case heat would produce, in regard to Typhus contagion, an effect analogous 
to that of cold, upon marsh miasmata, when the morbid action of the latter is sus- 
pended, until the following Spring or summer. 



350 
• 
frequent disease) back to their own country in British trans- 
ports ; and though this fever did not appear in that army, 
after their arrival in Spain, until the Autumn and Winter, it 
certainly began then to prevail therein to a considerable ex- 
tent. It will be remembered that in the latter part of that 
campaign, the British army, twice crossed that of Romana, 
and on both occasions Mr. Warren, Deputy Inspector of 
Hospitals, inforrrfed me that he had observed a considerable 
number of the Spanish Soldiers to be labouring under Xyphus 
fever. He added that the disease afterwards appeared among 
the French troops, as might well have been expected from 
their having occupied the barracks, quarters, and hospitals, 
which, in a long line of march, had just before been used, 
as well by Rom ana's as by the British army under Sir John 
Moore. This fact Mr. Warren stated, on what he thought 
good information, and particularly that of a British medi- 
cal officer, who had remained with the British Hospital left 
at Lugo. 

Whether at either of these crossings the British army re- 
ceived any febrile contagion from the Spanish, or whether 
they found any of it on board the transports in which they 
returned from Corunna, some of which had, as I understand 
been employed in removing the Spanish army from Denmark, 
is not, I believe, well ascertained ; but I think it highly pro- 
bable that in many cases, the cold, rain, and excessive fa- 
tigues to which the British soldiers were exposed, during a 
considerable part of Sir John Moore's retreat, and after their 
embarkation, might have brought into action the latent infec- 
tion of the preceding spring, the morbid influence of which 
had been suspended by the summer ; and I believe that typhus 
fever has, on some former occasions, suddenly made its appear- 
ance from similar causes.* Circumstances to be explained in 

* The learned and Reverend Stephen Hales, D. D. in his treatise on Ventilator-, 
(8° 175S) stales at p. 10G, that the convicts from Newgate often carry the Gaol 
temper with them, " to Virginia, before it breaks out'- As Dr. Hales, had some 

time before triken great pains to introduce the practice of frequent Ventilation in 






351 

another place, compel me to desist from any farther observa- 
tions on this subject, and to conclude the present chapter J by 
subjoining extracts from two letters, written to me by Mr. 
Grant, dated Plymouth Dock, the 24th and 27th of April, 
1 809, viz. 

•* Before the arrival of the troops from Corunna, this gar- 
rison was extremely healthy. Typhus did not exist in it, nor 
were there scarcely any sick in the hospitals, confined to bed ; 
but the effects of contagion very speedily developed them- 
selves amongst the orderlies, and others, employed in fatigue 
duties, connected with the hospitals. They seem, however, as 
speedily to have disappeared, as we have scarcely a dozen febrile 
diseases now in the garrison, and these are orderlies who have 
been taken ill since collecting the inclosed returns. The disease 
also became latterly very slight in its attack. In answer to 
your question, respecting the yellowness of skin, I have not 
seen many instances of it in this garrison ; the proportion 
not exceeding 2 to 100 : scarcely an hospital that has had two 
or three cases. One of the medical officers who died, Hos- 
pital Mate Williams, was of this description." 

Extract trom the second letter, viz. — 

* It may be also aiding your enquiries to remark, that in 
the naval hospital here, where some of the sick from Spain 

the ships employed in transporting criminals from Newgate to America, and had 
collected good information on the subject, it is to be regretted that he did not men- 
tion this fact more circumstantially, and especially that he did not inform us, wheth- 
er this complete suspension, for probably two or three months, of the action of Ty- 
phus contagion, after it was received into the body, happened in cold or. hot weath- 
er. That it was not always suspended so long, is evident by a fact which the same 
respectable author had mentioned in the preceding page, of the breaking out of this 
distemper, "in Mr. Reid's convict transport ship the Laura, notwithstanding the 
ship was frequently refreshed by Ventilation." The Convicts (says he) were put on 
board, the latter end of April, in seeming good health, and continued so until they 
anchored in Stromness Bay, in the Orcades, when between the 11th and fifteenth 
of May, a great part of the people fell sick of the Gaol distemper, in the compass of 
two days." He adds in the next page, that the contagion was in that case supposed 
to have been brought on board the.Laura by the convicts from NeAvgate. But we 
have no means of ascertaining how long they had imbibed it before they were remov- 
ed from that prison. 



352 



Were accommodated, 24 nurses, and seven labourers, wer 
taken ill of fever, in attendance upon them ,• of which number^ 
four nurses, and three labourers have died. Previous to this 
occasion, I am informed by the medical officers of that estab- 
lishment, that it was a rare occurrence for the servants of the 
hospital to be taken ill with fever, in attendance upon the 
sick. 

" At Pendennis Castle, Falmouth, where some sick from 
Spain also debarked, the progress of contagion was more 
rapid, extensive, and fatal, (in proportion to its field of ac- 
tion) than in any of the other hospitals in this- district. All 
the medical officers and servants stationed there, (the North 
Hants Militia,) were speedily taken ill, and one-fifth of the 
regiment, viz. 103, of which number, 11 died." 



CHAP. It 



OBSERVATIONS ON DYSENTERY. 

By the Greek name of this disease, (Aus-eve^i*) signifying a 
pain, or griping of the howels, Hippocrates intended to de* 
signate both ulcerations and hemorrhages from the intestines, 
and every kind of flux, with, or without blood, from them* 
After his time, however, this name seems, in its application, 
to have been restricted to an ulceration, or supposed ulcera- 
tion, of this part of the alimentary canal, with gripings and 
tenesmus, producing or attended by mucous, or bloody stools* 
Now T , however, an intermixture of blood with the stools, 
though of frequent occurrence, is not deemed a characterise 
tic of dysentery, nor is ulceration of the intestines ; but when 
the disease has been of long continuance, they are often found 
after death, to have been ulcerated, and even sphacelated. A 
spasmodic constriction of the colon, retaining the natural, 
but hardened, faeces commonly attends this disease ; and Dr« 
Cullen superadds* as a part of character u contagious py* 
rexia," though this addition seems objectionable, in regard 
to contagion, which I am convinced is not generally, if ever, 
connected with dysentery. Sydenham, when treeiting of the 
dysentery of 1669, says, " After having attentively con- 
sidered the various symptoms of this disease, I discovered it to 
be a fever, sui generis, turned inwards upon the intestines.'* 
Dr. Balfour, in his account of this disease, as it occurs in 
Bengal, has called it an u intestinal remitting fever;" and 
Dr. Rush, who supposes it may be connected with jail fever, 

45 



354 

as well as with the fevers from marsh effluvia, omits the word 
remitting, and calls it " the intestinal state of fever." (Medi- 
cal inquiries, &c. vol. iv. p. 167.) He moreover contends, 
that after a fever has been thus thrown upon the intestines, 
so as to occasion dysentery, it may, by a retroversion, bo 
translated to the skin, and there produce rash, prickly heat, 
and eruptions of various kinds.* 

Dr. Akenside, in his Commentarium de Dysenteria, in- 
stead of Sydenham's belief that this disease was a "j'ebris in- 
troversa," seems to consider it as an introverted rheumatism, 
or, as Dr. Rush would call it, the intestinal state of rheuma- 
tism; and with this notion, the former supposes that like or- 
dinary rheumatism, dysentery may be either accompanied 
with fever, or divested of it. He supposes, also, that it al- 
ways begins with the smaller intestines, and gradually de- 
scends to the rectum, and that rheumatism and dysentery are 
frequently converted into each other. 

Sir John Pringle considers " all the epidemic dysenteries," 
as being " of the same nature; 99 (see p. 223,) and in support 
of his own opinion on this subject, lie appeals to the experi- 
ence of the late Dr. Huck Saunders ; " not only in Germany, 
but in Minorca, America, and the West Indies ;'' in all of 
which, notwithstanding the differences of climate, this disease 
appeared " with the same symptoms, (though with more or 
less violence, according to the heat.) and yielded to the same 



* If such a translation of dysentery to the surface of the hody can be effected by 
art, it should, I think, always be attempted, as speedily as possible, because Uie attempt 
will be more likely to succeed while the disorder is recent, and because the danger 
of a disease in the skin, is much less than of one in the intestines. In a case of severe 
diarrhea, with which I was partially acquainted, and which was suddenly stopped by 
opium, Peruvian bark, and sudorifics, near a dozen large biles were produced on 
different parts- of the body, within three or four days ; and when these had suppurated, 
others supervened in succession, for several months, but gradually diminished in 
size, though not in number, until near the time of their total disappearance ; since 
which, the patient, though more than sixty years of age, has for six years enjoyed 
better health, than in any former part of his life. I barely mention the fact, leaving 
others to judge, whether this improvement in the patient's health, resulted in any de- 
gree from the biles^ which to him were a new, as well as a troublesome occurrence. 



355 

medicines." That this is true of epidemic dysentery, I can 
readily believe ; being convinced that this disease never pre- 
vails epidemically, unless it proceeds, from marsh miasmata, 
whose morbid influence is then, from particular circumstances 
or causes, directed and exerted upon the intestines, rather 
than upon the heart and arteries. 

This connexion between dysentery and marsh fevers, has 
been suspected and believed, by several respectable authors ; 
but I do not recollect that the identity of their causes has 
been any where so decisively manifested, as it was at the town 
of Sheffield, in the state of Massachusetts, during the summer 
and autumn of 1796, according* to a very circumstantial and 
apparently accurate statement, made by William Buel, the 
principal physician of that town, who had previously given 
an account (published by Mr. Webster) of the febrile disorders 
which prevaled there, during the three preceding years. The 
statement regarding the year 1796, may be found in vol. 1, of 
the New- York Medical Repository, p. 439 — 459, and the fol- 
lowing are extracts from it, viz. : 

" The part of the town in which the sickness prevailed, is 
almost a perfect level. The river Housatonak, whose width 
is generally between 30 and 40 yards, runs through it in a 
serpentine direction, and with a very gentle current." — " On 
each side of this river, there is a considerable extent of luxuri- 
ous meadow-ground, whose surface is generally overflowed, 
when the snow melts in the spring, and sometimes by freshets, 
at other times in the year. This meadow-ground is all much 
interspersed with coves or pools, which are left after the sub- 
siding of the flood, full of stagnant water ;" — and this " is 
in the course of the summer evaporated from some to dryness, 
and from others nearly so." — " Beside the meadow adjoining 
the river Housatonak, there are several other streams, which run 
through large tracks of flat, and very marshy land. On one 
of these streams, towards the north part of the town, there is 
a mill-pond, which appears to have been the common centre 
of the sickness in 1796, and the preceding sickly * years*" 






356 

i£ This pond overflows a large track of land, which was for- 
merly covered with a luxuriant growth of timber, and other 
vegetable productions, which are all now dead, and in a state 
of dissolution, in consequence of the action of air and water 
upon them :" — " whenever a dry season occurs, the water 
recedes from almost the whole of the land last flowed,* and 
leaves the whole mass of dead animal and vegetable substan^ 
ces, lying on its surface, exposed to the action of a scorching 
sun/' 

66 The fsetor which arises from this drowned land, when 
made bare by dry and hot weather, is extremely disagreeable, 
and offensive to all who approach its borders." — " The stench 
is smelled by the inhabitants at times even to the distance of 
half a mile ; an exposure to the effects of this noxious effluvium 
contiguous to its source, not unfrequently in the year 1796, 
produced immediate nausea and vomiting." The writer, after 
observing that the spring of this year had been uncommonly 
wet, adds, ** we had such an excess of rain even through the 
month of June, that all our streams, ponds, coves, and marsh- 
es, were kept full, and even our dryest land was highly sur- 
charged with water." But from the beginning of July for- 
ward, we began to suffer from the othei* extreme; we very 
seldom had rain, and uniformly the weather was intensely hot, 
particularly in the month of August :" — " the drought was 
so great, that vegetation was much injured ; grazing grounds, 
particularly, were parched almost to dryness." 

After these explanations, the writer gives a particular ac^ 
account of a considerable number of cases of dysentery, which 
occurred before the 20th of July, within what he afterwards 
describes as M the sickly circle;" adding, that within a few 
days other persons, within the same limits, were attacked 
with bilious or marsh fever. « From this time, (says he) 
instances of this fever frequently occurred, so that it was ap 

• By the " land last flowed" the writer means a large extent of ground, over 
which the mill-pond had recently been extended, by raising the mill-dam seven feet 
above its former height. 



357 

parent both disorders were endemic." — " In a short time, 
both prevailed to a degree truly calamitous and alarming." — 
" Let (says the writer) an imaginary circular line be described, 
from a point on the south-eastern side of the above-mentioned 
mill-pond, whose radii shall be one and one-half mile in 
length 5 this circle will embrace about 100 families, and about 
600 inhabitants ; it would comprehend the whole territory in 
which the sickness prevailed, with so much exactness, that 
there would be considerably short of 10 families without its 
limits in which there was sickness, and there certainly were 
not 10 within which were exempt." Of about 450 persons in 
the eastern half of this imaginary circle, '* at least 250 were 
affected with sickness $ of the 150 who dwelt nearest the pond, 
there were not 10 who escaped."* 

6i The dysentery frequently came on while the patient was 
affected with bilious fever. In this case the type of the fever 
soon became obliterated, and the accompanying febrile symp- 
toms were similar to those in original dysentery. The change 
of the fever into dysentery, did not, however, secure the pa- 
tient from the tendency to relapse, so peculiar to that disorder. 
But the convalescence of those who had simple dysentery on- 
ly, was generally short, and the recovery perfect. 

" Sometimes the fever came on upon the dysentery. The 
type of the fever was not in this case easily ascertained, un- 
til an abatement of the dysentery took place, when, as the 
dysentric symptoms subsided, the fever would appear in its 
proper form. The two disorders appeared to be complicated ; 
that is, they both seemed to exist at the same time, rather 
than to act in alternation. The fact is certain, that in cases 
of accession of dysentery upon the fever, the latter disorder 
always showed itself in its true form, after the symptoms of 
the other had subsided. 



* It is not to be supposed that marsh miasmata, arising from the mill-pond, exclu- 
sively produced disease at the distance of a mile and an half; other sources of them 
•were interspersed throughout the whole circle here imagined. 



338 

*•' In the sickness which makes the subject of this communi- 
cation, there is every reason to ascribe identity of cause to the 
two disorders. They were circumscribed in a Aery striking 
manner, by precisely the same limits. They both began and 
ceased to prevail at the same time. Neither disorder occurred, 
(except in a few instances of both disorders about the pond, 
at the south part of the town,) at any considerable distance 
from the limits, but in persons who had previously resided 
within them. There were instances of both disorders affect- 
ing persons in different parts of the country, who had resid- 
ed within these limits. A stay of only one night in the cen- 
tral part of the sickly territory, in some instances produced 
these disorders. 

" The facts which I have stated, prove sufficiently, that 
neither of these disorders was propagated by specific conta- 
gion, at least beyond certain boundaries, otherwise they must 
have extended, for there was no interruption of communica- 
tion. I have remarked before, that I was myself convinced 
that neither disease was propagated by specific contagion, 
even within these boundaries. In all cases which came under 
my observation of sickness without the limits, and acquired by a 
residence within them, there was no instance of either com- 
plaint being communicated from the person affected." Here 
it should be observed, that the town in which these disorders 
were produced, is situated near the northern boundary of Mas- 
sachusetts, where the summer heat is commonly much more 
moderate than in Pennsylvania, and other states, in which 
the yellow fever has often prevailed. 

This connexion of dysentery with marsh fevers has been 
also noticed, in different parts of the United States, and in 
many other parts of the globe.^ Dr. John Vaughan mentions 
the former disease, as prevailing over certain low districts* 



* Dr. Cleghom (Diseases of Minorca, p. 134,) says, " Sometimes a tertian is 
changed into a dysentery, or a dysentery becomes a tertian ; and when one of these 
diseases is suppressed, the other often ensues." He adds, that it is not uncommon, 
ibr " the fits of tertians to be regularly accommpauied by gripes and stools." 






359 

Adjoining the Delaware, and evidently resulting from marsli 
effluvia. — See N. York Med* Rep. vol. Hi. p. 223. Dr. 
De Rosset, also, in giving- an account of the Bilious Yellow 
Fever, of 1796, at Wilmington, in North Carolina, (which 
I noticed at p. 24S-9 of this volume) mentions it to have been 
preceded in July and August, after excessive heat, by the 
dysentery, which "soon became general, proving fatal in 
many instances." He adds, " towards the close of August, 
when the first cases of bilious fever occurred to me, the 
dysentery began to decline ; and scarcely one new case of it 
occurred after the fever became more prevalent. It may be 
here remarked, that every person who had laboured under 
the dysentery, without an exception within my knowledge, 
escaped the fever." 

It is remarkable that here, as well as at Sheffield, the 
morbid influence of marsh miasmata first manifested itself in 
the form of dysentery. This, I believe, does not always 
happen. Dr. James Clark, in bis Treatise on the Yellow 
Fever at Dominica, says, (page 103) that u the dysentery 
generally prevails at the same time that the remittent and in- 
termittent fevers do, in the West Indies, and probably from 
the same cause." Dr. Trotter observes, that on the coast o£ 
Africa and the West Indies, dysentery " is joined with inter- 
mittent and remittent fevers." (Med. Nautica, vol. i. p. 
378. 

Of the East Indies I have no personal knowledge; but it 
is notorious that marsh fevers and dysentery are there com- 
monly produced by the same cause, and at nearly the same 
time :* that both often occur in the same person, and they are 
said to be not unfrequently complicated with chronic inflam- 
mation of the liver, to which the greater heat of that climate 
seems to dispose the inhabitants in a remarkable degree- 

* Dr. Ffirth says> that of the crew of the ship in which he went to Batavia, 70 in 
number, all, except eight, had either marsh fever or dysentery ; that "the fever ap- 
peared to alternate with dysentery ; wheji he weather was bad, the latter prevail- 
ed ; when good, the former." 



360 



But, without leaving Great Britain, we may find evidence of 
the influence of marsh miasmata in producing dysentery, from 
its appearing in those places, and at those seasons, in which 
they were known to be morbidly active. Even London, 
though now almost exempted from their effects by a change of 
circumstances, was formerly very much infested by them ; 
and Sydenham remarks, that the dysentery never prevailed 
until the latter part of summer, and that it disappeared at 
the approach of winter, resembling marsh fevers in these 
respects. He has, indeed, omitted to notice those peculiari- 
ties of the season which render marsh effluvia most powerful, 
because he ascribed diseases not so much to the sensible as to 
the occult qualities of the air, which he called its constitution. 
Dr. Willis, however, has (as Sir John Pringle observes) sup- 
plied this omission, In regard to the dysentery which prevail- 
ed in London in the autumn of 1670, by mentioning that it 
began after an exceeding hot and dry summer ; " post sesta- 
tem impense calidam Sf siccam." (See Pharma. Ration, sect. 
iii. chap. 3.) Sir George Baker, also, (de Dysenteria Lon- 
din. an. 1762) mentions that this disease, in the latter year, 
appeared as an epidemic, about the end of July, after very hot 
and dry weather; and that it raged until November. Sir 
John Pringle also observes, (p. 251) that in this year 1762 
" the summer heats and drought were of a longer continuance" 
than he ever observed in this country, and that in the autumn 
more cases of dysentery " occurred, than in all the sixteen 
years that" he "had resided here." — And Dr. Huxham, 
without appearing to suspect the influence of marsh effluvia, 
has remarked the prevalence of this disease as a consequence 
of hot summers. "Post fervid am sestatem, constanter fere 
sequunter cholera, dysenterise, alvi fluxus." (De Aere & 
morbis epidemicis, t. ii. p. 176.) 

But that I may not unnecessarily extend these quotations 
I shall content myself with referring to Sir John Pringle's 
" Observations on the Camp Dysentery," among which are 
the following, viz. 



361 

a I have never known the dysentery epidemic, unless in 
summer or in autumn, when the primse vise are most liabie to 
be disordered." (Diseases of the Army, p. 224.) He might 
have added, and when marsh miasmata are most powerful. 
Again, at p. 226, " Frequently the beginning of a flux will 
have all the appearance of an autumnal fever ; for the patient 
will be feverish, with disorder in his stomach and bowels, for 
two or three days before the purging comes on ; but after 
that, the fever sensibly gives way." And again, at p. 253, 
44 Hitherto we have seen how similar the causes are, of the 
remitting and intermitting fevers, and of the bloody-flux. 
Nay, the affinity extends cwen to the occasional or exciting 
causes ; such as when, in the end of summer, or in autumn, 
the men are exposed to night damps* and fogs, especially after 
a hot day, or lie upon wet ground, or in wet clothes, part of 
them will be seized with that kind of fever, and part with this 
flux; and perhaps some of them will have a disorder com- 
pounded of both. Add to this, that those fevers begin to bo 
frequent in camp whilst the dysentery still subsists ; that the 
first symptoms are often similar, such as the rigors, and disor- 
der of the stomach ; that the remitting and intermitting fevers 
of a bad kind have sometimes ended in a bloody-flux ; that siich 
countries as are most subject to those autumnal remitting fevers, 
are likewise most liable to the dysentery ; and that the analogy 
continues even to the metJwd of cure, in so far as the principal part 
of it consists in clearing the primse vise. Upon the whole, 
the nature of the two distempers appears so much alike, that, at 
first sight, Sydenham seems to have expressed himself justly, 
when he called this flux u the fever of the season turned upon 
the bowels." But upon a nearer view we shall find this no- 

* It is remarkable that, noi withstanding all that Lancisi and others had written 
of the influence of marsh effluvia in producing fevers, Sir John seems to overlook 
their effeets, and ascribe them to cold and moisture. Hence, though he considers 
dysentery, and remitting or intermitting fevers, as having similar causes, he makes 
bo mention of marsh miasmata as occasioning either, even where they prevail most 
extensively, as in Flanders, &c. It is, indeed, true that he supposes the moisture to be 
rendered more hurtful by the effects of putrefaction in marshes^ 

46 



362 



tion more ingenious than solid, since the circumstance of its 
being contagious, shews that the dysentery is essentially differ^ 
ent from those fevers." 

Here we find that this justly-distinguished physician, after 
stating facts and reasons the most forcible, for considering 
marsh fevers and dysentery as produced by the same cause, 
gratuitously assumes the latter disease to be contagious, and, on 
that assumption, in opposition to these facts and reasons, in- 
fers that the latter disease " is essentially different from those 
fevers." We shall, however, soon find reason to think that 
contagion is not a quality belonging to dysentery, unless it be 
in cases which are occasioned by, or complicated with, typhus 
fever, if, indeed, such cases ever exist ; and we may there- 
fore conclude, that marsh miasmata, acting in a particular 
direction, are a frequent cause of dysentery ; indeed, there is 
good ground for believing that it never becomes an epidemic, 
without their co-operation. 

The causes which determine the morbid influence of marsh 
effluvia towards the intestines, so as to excite the disease in 
question, rather than intermitting or remitting fevers, do not 
seem to be yet well understood. Dr. Blane thinks, when per- 
sons are pre-disposed to that morbid action which may termi- 
nate either in fever or dysentery, that the latter disease " is 
more likely to arise from an irregularity in eating or drink- 
ing: — a fever from being exposed to the weather," &c. 
There can, however, be no doubt, but the latter of these 
causes, (supposing it to include the application of cold and 
wet to the skin,) is often productive of dysentery, either 
alone, or in conjunction with miasmata and other causes. 
Indeed, there are but few persons who have not some time been 
made sensible of the sudden effect of such applications, in pro- 
ducing diarrhoea at least ; though I am far from thinking that 
improper food, by irritating and disordering the bowels, does 
not also co-operate in exciting dysentery ; and under the head 
of improper food, I would include sharp, acid fruits, when 
eaten to excess, such as pine apples, which Dr. Moseiey 



363 

mentions as having caused the disease. I think, however, 
that in this, as well as other cases of dysentery, which were 
chiefly in his contemplation, marsh effluvia must have been 
the principal cause; for at p. 214 he notices the stools, as 
being " more frequent, and all the symptoms more aggravat- 
ed, at those hours when the current fevers are in their exacer- 
bations, and the reverse when those fevers are in their remis- 
sion ; besides the alternate succession of one disease to another, 
which (says he) I have frequently observed i" and this, to 
my apprehension, clearly indicates the influence of marsh 
miasmata, though he adds that it cannot " be doubted but 
this fever of the intestines, like most others, is caused by ob- 
structed perspiration."* 

But besides the production of dysentery by the operation of 
wet and cold, conjointly with miasmata or other causes, this 
disease has, in many instances, been apparently occasioned by 
their operation alone. 

Of this Sir John Pringle gives a remarkable instance, at 
p. 19 of his Observations on the diseases of the Army, viz. — 
** On the 26th (of June, 1743,) in the evening, the tent? were 
struck, the army marched all night, and next morning fought 
at Bettingen. On the night following, the soldiers lay on the 
field of battle without tents, exposed to a heavy rain. Next 
day we moved to Hanau, and encamped on good ground in an 
open field ; but it was then wet,f and for the first night or 
two, the men wanted straw. By these accidents, a sudden 
change was made in the health of the army ; for the summer 

* A.n obstruction of perspiration, to with (in conformity with the principles 
of the Humoral Pathology) the dysentery is here ascribed, probably is not a cause 
of it, as occasioning a retention of matters which ought to have been excreted (and 
for which nature has provided other outlets when wanted,) but as being generally 
accompanied with a morbid distribution of the blood, and an improper determination 
of the living power inwardly to the intestines, followed by increased, or inflammatory 
actions in their vessels. 

f Dr. F. Home (at p. 26 of his Medical Facts and Experiments,) says there were 
"two rainy nights, after the battfeof Dettingen," which " produced the bloody 
flux." 



364 



had bcguit early, and the weather had been constantly warm, 
6cc." — M Now the pores were suddenly stopped, the body was 
chilled, and the humours tending to resolution from the pre- 
ceding heats, were turned upon tJie bowels, and produced a 
dysentery, which continued a considerable part of the cam- 
paign. In eight days after the battle, about 500 men were 
seized with that distemper, and in a few weeks nearly half the 
men were either ill, or had recovered of it." 

Dr. Trotter mentions a lamentable dysentery, which was 
produced on board the Berwick, ship of the line, in October, 
1780, in consequence of the hurricane on tyc 5th of that 
month, by which the clothes and bedding of the seamen, and 
indeed every part of the ship '•' were soaked in water," and 
many of the men " slept for nights together on the wet 6V 
overcome with fatigue, and debilitated from the want of food." 
In seven weeks thirty of the best men died of this disease, in 
some cases complicated with scurvy, and " near 300 of the 
vship*s company were ill," when she arrived at Spithcau. 
(Med. Nautica, vol. i. p. 378, &c.) Dr. Most- 1 \ says, ••' it 
has often happened that hundreds of men in a camp have btvn 
seized with the dysentery, almost at the same time, after one 
shower of rain, or from lying one night in the wet and cold.*' 
(See his Treatise on Tropical Diseases, 3rd edition, p. -268.) 
I suspect, however, that in such cases, the disease is not ex- 
actly like that which principally results from marsh etlluvia; 
that it has a greater similitude to diarrhoea, and if accompa- 
nied with fever, that this is nearly related to that of catarrh. 

Another supposed cause t)f dysentery has been alleged by 
so many respectable authors, that it would be improper in me 
to reject it, though I have never seen any decisive or convinc- 
ing evidence of its operation in this way : what I mean is 
typhus fever, or its contagion. Dr. Blanc, at p. 394 of his 
work on the Diseases of Seamen, says. u when this typhus) 
fever prevailed on board of any ship that arrived fi-om a 
northern climate, it was soon after succeeded by, or converted 
into, a dysentery •> for the ships that arrived either from Eng- 



365 

land or North America, with the greatest stock of fevensk 
infection, were the most subject to fluxes, after being two or 
three months in the West Indies." Dr. Trotter asserts that 
typhus fever was combined witli dysentery in the transports 
whicli conveyed the army under Lord Moira to Ostend, in 
the year 1794 ; (see p. 378) and Sir John Pringle says, (p. 
227) " The most fatal sort of fever, which so often attends 
the dysentery of the army, though not essential to it, is the 
hospital or jail distemper." — * This fever (he adds) com- 
bined with the bloody flux, was generally mortal." But sup- 
posing, as I am willing to do, that Sir John Pringle has com- 
mitted no mistake concerning the true nature of the fever in 
question, it may, notwithstanding, become a matter of doubt, 
whether the dysentery in these cases, w T as the consequence of a 
typhus fever inverted or thrown upon the intestines, or whe- 
ther the patients had been exposed both to marsh effluvia and 
febrile contagion at different times, and that each having 
produced its effect separately, the fever and flux were thus 
accidentally combined ? In either of these cases, however, 
we may understand, and perhaps believe what the same author 
asserts at p. 103, i. e. that " the putrid effluvia of the dysen- 
teric fseces, are not only apt to propagate flux, but likewise 
to breed the jail or hospital fever, with or without bloody 
stools :" for the excretions of patients under the action of con- 
tagion, may reasonably be expected to become contagious ; 
though I cannot believe that dysentery ever possesses that 
quality, when it is not derived from, or connected with that 
cause. 

G. Fabricius Hildanus, in his Treatise de Dysenteria, cau- 
tions persons in health not to approach the places where 
dyscnterical excrements are deposited, lest they should be 
infected ; adding, that the exhalations of such excrements 
affect the bowels of persons in health, by some occult quality. 
Afterwards, Sennertus mentioning the dysentery, which oc- 
curred in 1624, after great heat and drought, says that one 
person was infected by another* and that whole families died 



366 

of it. But there seems to be good reason for believing;, that 
the disease here mentioned was occasioned by marsh effluvia, 
and that their effects were, as they have been on so many oc- 
casions, mistaken for those of contagion : and this was proba- 
bly the case with Sir John Pringle in Flanders, whenever the 
disease prevailed as an epidemic, which was always at a time 
of the year when febrile contagion must have been nearly 
inactive, and when marsh effluvia were most powerful. 
denham no where intimates that his epidemic dysentery was 
contagious, and Willis distinctly asserts that it was not. I 
Sir John Pringle admits (p. 235) u that this disorder i 
so catching as most others of the amtogimu hind;*' but adds 
that he " always found it in some degree inf«< tioos, especial]) 
in military hospitals," whenever it was " tfidemfcf and this. 
according to his own explanation in other places, was always 
in the summer and autumn, when marsh effluvia wen most 
abundant and active, and when febrile contagion must have 
been hast so, and therefore when it was most easy to confound 
their effects. It is moreover absolutely incredible, that ■ 
effluvia should produce contagion, when they disorder the 
bowels, and not produce it when the) Oceania* intermittent 
and remittent fevers. Mr. Boa- doubts whether dysenfc 
ever contagious in the East Indies;* and all the medical 
gentlemen from that climate with whom I have cbnvei 
have entertained similar doubts, or rather believed it not to 
he so. Dr. Mosely saw •• as to contagion from infecti.m in 
dysentery. 1 must confess I never saw an instance of it : nei- 
ther do I belie\e there is any such thing." ^p. 267.) If. 
Bruant, physician to the French army in Egypt, says the 
dysentery was not contagious in the great hospital the 1, 
of Ibrahim-Bey,} at Cairo, where he officiated with three 
other physicians, though it had long been crowded tcith mk* 99 
See Hist. Medicale de L/armee d'Orient. Me partie. And in 



• Sec Medical Tracts, &c. vol. iv. p 13. He thinks the climate of that country 
unfavourable to the production and propagation of contagious 
that even the small pox gradually disappears as the summer advances. 






36^ 

regard to my own experience, I have no hesitation in declaring, 
that with thousands of soldiers in that disease, under my care 
at different times, and often much crowded in hospitals, bar- 
racks, and transports, I never have been able to discover any 
sufficient reason to believe that the disease was communicated 
by any of them to any nurse, orderly man, or other person.* 

I shall conclude this chapter by a very few general obser- 
vations on the treatment of dysentery. 

As in this disease there is manifestly a morbid determina- 
tion of febrile or inflammatory action upon the intestines, I 
think, and have always found it beneficial, speedily to coun- 
teract this disposition, and produce an opposite determi- 
nation ; so far at least as to create a salutary distribution of 
the blood, and of the living power, throughout the body, and 
especially upon its surface, by suitable diaphoretics, combin- 
ed with opium in small doses ; by the application of flan- 
nels, immediately to the skin, and more especially round the 
abdomen ; and in urgent cases by the warm bath, (continued 
for the space of an hour, if the patient can bear it so long,) 
warm fomentations, and especially blisters upon the belly, 
taking care at the same time to promote sufficient evacuations 
by stool, to relieve the intestines as much as possible from all 
irritation and uneasiness, which they might suffer by a reten- 
tion of hardened faeces, or scybala, and other matters. For 
this last purpose, the neutral purging salts, with manna, are 
proper, or a mixture of the oleum ricini, with the juice of a 
ripe orange, and a little mucilage of gum-arabic, which will 
agree better with most stomachs, and prove equally effica- 
cious; emollient purgative clysters may also be employed. 
Should the disease be attended with considerable fever, care 

* I have now before me a statement which I made on the 5th of May, 1806, oP 
certain facts communicated to me on that day, by Dr. Macdonald, who was a staft* 
surgeon with the army in the Netherlands, under the Duke of York, in 1793 and 4, 
derisively proving, that a dysentery which prevailed to a great extent, and in the 
worst fonn among the French prisoners, accumulated at Ghent to *he numher of 
nearly 4,000, did rot manifest ttue slightest contagions property. 



S6S 



must be taken not to increase it by the too frequent use of 
diaphoretics and opium. When the disease, by long protrac- 
tion, has occasioned ulcerations of the intestines, and more 
especially when it is complicated with an affection of the 
liver, calomel should be preferred as a purgative, and it 
should also be employed with opium, so as to excite a sore- 
ness of the mouth. 

The food in dysentery ought to be light, and easy of di- 
gestion ; indeed, the stomach will commonly bear no other. 
The amilaceous matter of the Maranta arundinacea, or In- 
dian arrow-root, boiled witti milk, barley, and chicken-wa- 
ter, salop, tapioca, 6cc. are generally the most acceptable, 
as well as salutary. But if the patient should have any par- 
ticular craving, it may almost alwys be safely indulged. 

The best means of obviating this disease, especially in ar- 
mies, deserve consideration ; and, among these means, there 
is, I believe, none which would prove more generally effica- 
cious, than constantly wearing flannels round the belly, and 
next to the skin : the allotment of muscular fibres to that part 
of the body is very sparing, and so is its power of resisting 
cold. In Germany, Italy, Spain, and Portugal, people of the 
lower order, very generally wear sashes of woollen stuffs 
round their waists ; and I have observed a similar practice 
among the Turks and Arabs, which, however it began, has 
probably been continued from a conviction of its beneficial ef- 
fects in preventing disease. Dr. Grainger, at p. 36 of his 
Essay on the more Common West India Diseases, (2nd edi 
tion) makes the following just observation. " One should 
imagine it would be hardly necessary to advise to cover the 
bellies of the diseased (under " fluxes" with rearm blankets ; 
and yet for want of this simple precaution, I have known ma- 
ny negroes lost." 



CHAP. III. 



OBSERVATIONS ON THE PLAGUE. 

Upon my return from Egypt, in 1802, I employed some time 
in reading, and making extracts from, such scarce books, and 
manuscripts, relating to the plague, and sweating sickness, 
as I could find in the British Museum, the libraries of Uni- 
versities, (particularly that of Oxford) and other collections, 
partly for my own satisfaction, and partly with an expecta- 
tion of publishing something on these diseases, they having 
previously engaged my attention in some degree. This ex- 
pectation, however, has not been fulfilled ; because, though 
my researches were not unproductive of curious matters, I 
have doubted whether they would prove so generally interest- 
ing, or so practically useful, as to render a publication of 
them desirable ; and in regard to what I had either seen or 
thought of the plague, I hoped that Drs. Buchan and Price, 
army Physicians, who underwent the disease in Egypt, would 
render any contribution from me of no importance, by giving 
to the public the results of their own more extended expe- 
rience on that subject. But as this hope is now almost extin- 
guished, and as opinions which I think erroneous have been 
extensively propagated by high authorities, some of which 
confound the plague with Typhus, and others with yellow 
fever, I cannot allow the present volume to go into the world, 
without adding some facts and conclusions, tending, as I hope, 
to stop the progress of error ; and founded, not only on a con- 

47 



370 



siderable share of reading, and some personal observation } 
but on valuable communications, with which I have been fa- 
voured, by medical gentlemen, who were employed in the 
Pest-houses of Egypt, and some of them for a longer time 
than myself. 

In regard to the history of plague, I shall here introduce 
but a very small part of what I had collected and written on 
the subject. In the Hebrew, Arabic, Greek, Latin, and all 
other Ancient languages, with which we are acquainted, 
words are found signifying generally, (like the English word 
Plague) an extensive and destroying malady, when applied 
to diseases ; and Galen, who was for many centuries the oracle 
of medicine, has sanctioned this application of the term ; for 
he expressly sajs* that epidemic and plague, are not names of 
any particular disease ; but that the former designates a dis- 
order attacking many persons in a district ; and that when it 
proves mortal to great numbers, it then becomes a plague : and 
with these vague significations the words in question were 
long used. But in modern times, writers who aimed at more 
accurate discriminations, have appropriated the word phigue, 
and its correspondent terms in other languages, to signify ex- 
clusively a peculiar and very fatal disease distinguished by 
symptoms, to be hereafter mentioned, among which Glandular 
swellings in the groin, axillae, and neck, are the most constant 
and remarkable. 

I am convinced, by facts the most indisputable, that the dis- 
ease just mentioned, and to which alone I shall apply the 
name of plague, is not only distinct from all others, (or sui 



oTi tt?o etv koXXok; iv ev; yivtrfctt %a>ptu). roZro i"vi^rif*jai cvoum^-tai Tg«- 
g-£A0o'»t«s f'ttura reu -xoXXovs xiatgttv, XatfMt ynercct. Vid. Foesius CEeo- 

nom. l!ipj>oc. p 638. 

1 am informed by Mr. Brown, the African traveller, that Koubeh, and Webe, or 

Vebc, are terms now used by the Egyptians to designate the plague. The former 

signifies, a great mortality from disease, and the latter a gTOT.'e ,• and conjoined these 

words imply a disease which sends many people to their graves. 



371 

generis) but that it is, morever, specifically contagious, and, 
consequently, incapable of being any where produced, except 
from its own contagion ; and I think it highly probable that 
this disease has subsisted almost from the commencement of 
human existence, and been continued from generation to gene- 
ration, by its peculiar contagious quality ; though, from the 
want of proper discrimination, which is found in all the an- 
cient medical writers, and which might well be expected in 
regard to those diseases, which were ascribed to supernatural 
causes, there is, I believe, no clear, definite, and certain des- 
cription of the plague, anterior to that which Procoinus* gave 

* Procopius, a Greek Byzantine historian, was secretary to Belisarius, and attended 
him in the wars of Persia, Vfrica, and Italy, after which he became prefect or governor 
of Constantinople. It is in the second book of his History of the Persian War, 
(Chap. -J2,) that he gives an account of this plague. I have made the following trans- 
lation of those passages in which he describes the disease, viz. " Persons were seized in 
this manner: they suddenly became feverish, some whilst asle.p, and or hers, in their 
ordinary occupations. The body did not change colour, nor grow hot, nor inflamed, 
even with the fever, which was so moderate from the beginning, and until evening, 
that neither the patient, nor his physician, by feeling the pulse, apprehended any 
danger ; for no one could have suspected death from it : A tumor rose, in some on 
the first, and in others on the second day, but sometimes later, not only in the groin 
but also within the axillae, (armpits) and sometimes behind, or under the ears, or 
in some other part as might happen. These symptoms have hitherto appeared very 
constantly, in all who were attacked by the disease ; other symptoms were less con- 
stant. I cannot say whether from any differences in the bodies of the sick, or from 
the will of him who sent the disease." " In some there was a profound coma, in 
others a violent delirium." " Some died very speedily, others lived several days. 1 he 
body was spotted with black pustules of the size of a lentil, in some who did not live a 
single day ; but died immediately : others were carried oft* by a spontaneous vomiting 
of blood. This I can declare truly, that the most able Physicians often prognosticated 
the deaths of numbers who shortly after recovered surprisingly ; and, on the other 
hand, they have pronounced the recovery of many who were doomed to speedy death: 
so that in this distemper there was no reasoning which could assist human judgment ; 
no one being able, in most eases, to foresee the event. Bathing was beneficial to some, 
but to others it did harm. Many died who were left without attendance, while others 
in the like circumstances unexpectedly recovered. Again, all methods of treatment 
succeeded with some, though, in short, no certain means were discovered, either to 
cure or prevent the disease." To pregnant women the disorder was certain death, 
for those who miscarried died, and those who we*te delivered perished with their off- 
spring." " Itgenerally happened that those whose buboes grew large and suppurated, 
recovered from the disease, which seemed to spend its violence upon these tumors ;— 



372 - 

of the great plague that began about the year 542, and lasted 
more than half a century, destroying a great part of man- 
kind, as far as the world was then known. But there is, I 
think, great probability, that this disease was known to the 






1/ 



whilst ii th »«e whose buboes remained without suppuration, it had an unfavourable ter- 
mination." " fhisdisease lasted for four months at Byzantium, (Constantinople) though 
it raged most during three only. In the beginning few died beyond the usual number ; 
but the evil soon increased to such an extent, that the deaths amounted to 5,000 daihj and 
at length to 10,000 and upwards. At first, care was taken to bury the dead in Uie vaults 
of their families, but afterwards they were thrown into the sepulchres of others, some- 
times from ignorance, but often by violence. In the end an universal confusion pre- 
vailed ; servants being left without masters, and masters, once very opulent, deprived 
of servants by death or sickness. Many houses became desolate, and bodies some- 
times remained in them unburied, because none of their inhabitants had survived." 

Jigathias, another Greek historian, who lived about the same time, ami wrote an 
history of Justinian's reign, beginning where that of I'rocopius ends, mentions another 
violent eruption of the plague at Byzantium, where, he says it had never entirely 
ceased, from its commencement in the 5th year of that Emperor. He says, it de- 
stroyed myriads, and with symptoms like those which at first distinguished it. See 
the Greek edition, with the Latin version, and notes by Bonaventure Vulcanius, 
printed at Leyden, 1594, (4°) Lib. V. p. 148. 

A farther account of this plague was given by Evagrius Scholasticus, an ecclesiasti- 
cal Greek historian, who lived in the same century. He calls it, the inguinal plague, 
and says it began twoyears after the taking of Antioch> by the Persians (under- Cos- 
roes, ■•. D 540,) and that whilst he was writing it had invaded that city for the 
fourth time, having then lasted 52 years, and almost depopulated the world. The 
following is a translation of Ids description of the disease ; viz " In some persons, 
seizing the head, it rendered the eyes sanguineous,, and the face tumid ; then falling 
on the (glands of the) throat, it put an end to life, in all who were thus seized.*— 
Some were afflicted with discharges from the bowels ; in others an abscess lbrmed 
in the groin, and, being followed by a raging fever, the patient died on the second or 
third day with his body and mind apparently sound. " Some were seized with deli- 
rium and expired. Carbuncles arising on the body, extinguished life in many. Oth- 
ers recovered once, and afterwards died of the same disease. The modes of con- 
tracting the disease were various, and baffled all calculation. Some perished by once 



* In modern times, patients under plague have been speedily suffocated by such an 
affection of the sub-maxillary glands. 

Omens, at p. 96 of his Descriptio Pestis, after nentioning parotid swellings adds, 
«• Atq otquot snbmaxillaribus obnoxios vider. mihi contigit ob enormem intumescen- 
tiam p.trtiuin lary.igi proximarum, <rt inde productam siiffocuiionem omnes e vitK mi- 
grarunt Horrendum sane aspect'cun, a tumore vastissimo deformes oribus hiantibus et 
lingua exserta anxio anhelantes, prrebuerunt miseri." 



373 

Jews at an early period of their history, and that it was the 
disease mentioned in 1st of Samuel, chap. v. verses 6 and 9; 
and ch. vi. y, 19, under the name of " Emrods" (or He- 
morrhoids) according to the English translation; which 
seems entirely gratuitous ; the Hebrew word being (Apholin 
or Apholim) and its root (Apol.) signifying an eleva- 
tion, eminence, or hill, it properly denotes a tumor, or swell- 
ing, in some secret part ; and I believe, there is no sufficient 
authority for referring these tumors to the anus 9 rather than 
to the groin, where they would constitute buboes, and indicate 
the plague ; a disease which is much more likely than the 
piles to have spread extensively and destructively among the 
Philistines at Jlshdod, and to have been communicated by 
them, when they restored the ark to the Israelites, at Beth- 
Shemesh, and have there caused the deaths of 50,070 men;" 
who were thus afflicted, as is said, 4< because they had looked 
into the ark of the Lord." These swellings would have been 
as much in the u secret parts" of men wearing clothes, when 
placed in the groin, as if placed in the other situation. It 
may indeed be alleged as an objection to this construction, 
that, among the dreadful curses denounced in the 28th Chap- 
ter of Deuteronomy, v. 6, the Hebrew word which denotes 
Pestilence (Deber) is different from that which in the 2fth 
verse, has been translated Emrods. But there is no force in 
this objection, unless it can be ascertained, that the word 
Deber then signified the true plague, and if that be ascer- 
tained, it will prove this disease to have been known to the 
Jews at an earlier period, or soon after they left Egypt. 

From several passages in the writings of Hippocrates, it 
seems probable, at least, that the true plague had fallen un- 
der his observation. He mentions, at the 55th verse of the 



entering into infected houses" "Some by only touching the sick-" "Many who 
remained with the 'ick and freely handled them as weU as the dead bodies, wholly 
escaped the malady," Hist. Eccles. lib. if. c 29. 



374 

4th book of his Aphorisms,* that fevers accompanied with 
buboes are all dangerous, except ephemeralf fevers ; and this 
passage is repeated in the 7th section of the 2d hook of Epi- 
demics, with this addition,:): "and buboes occurring in fevers 
are more dangerous, especially if in fevers which are acute, 
they subside soon after their appearance :" and these observa- 
tions may be considered, as correctly applicable to the plague. 
It is also probable, that the disease which is described as|| 
prevailing among the fullers in the 5th book of his Epide- 
mics; 7th Section (page 1155 of Foesius's edit. E.) and also 
in the 7th book of the same, 7th Sect. (p. 1229. H.) was the 
plague : and this probability is heightened by this considera- 
tion, that, if the plague existed in the country, no class of 
men would be so liable to be infected by it as fullers, who 
were then very much employed in cleansing the woollen 
clothes almost univei-sally worn in those days. 

* Hippocrates Aphor. 1. iv. 55. Oi ix) SxGeiffi irvptrot x«»7fs x&xti xMf 

f By the exception here made in regard to ephemeral, he appears to have meant 
those short and mild levers, of one paroxj^ru, which so frequently attend the suppu- 
rative process in buboes, caused by absorption. These buboes are well described by Ga- 
len, in the 15th book of his MethodusMedendi ; of which description the following is a 
translation. "Thus also, from an ulcer coming on a finger, either of the foot or of 
the band, the glands in the groin and the axilla, swell and inflame, upon first receiv- 
ing the blood returned from the extremity of the limb : and about the netk, and the 
ears, glands have often swelled from ulcerations either upon the head, or the neck, or 
some of the neighboring parts. They call glands thus swollen buboes.'" 

$ 0. : iiei QxZuG-i levgtrei xxko* -zrXvn rut iQr.nipm, xx\ et ht* vvfi- 
Tcuri £h£a>ve$ xaxi'eieq iv ro7<riv o^ea-it i%*%yjr.<i lex^ax^'a-xirt?. Hipp. Epid 
Lib. 2. Sect. 7. Fees. p. 1025. 

U " Among the fullers tubercles arose in the groin, which were hard, and not pain- 
fid; others also of the same size about the pubes, and in the neck. There was fever, 
at first attended with coughing. On the third or fourth day the bowels were affected 
with diarrhoe ; heats supervened, with diy tongue, and thirst The alvine discharges 
were very bad ; they died." In this translation 1 have taken the liberty of altering 
the passage, Tf iT|i fi.nu rer^Te*) which is obviously defective, into ^.ttj u<* r 
T£T«*t>j, wliich I conceive to be the only proper reading. 



375 

These are the parts which favour most the supposition that 
Hippocrates was acquainted with the plague. Galen, indeed, 
mentions (in lib. de Therm, ad Pison.) that Hippocrates put 
an end to the plague at Athens, by lighting fires ; but, after 
the definition, before quoted, of the plague by this author, we 
can have no certainty that the disorder then prevalent in 
Athens was the true plague. 

It does not appear, however, that Hippocrates knew either 
the peculiar nature of the plague, or its contagious property. 
I have not indeed met with any passage in his writings which 
clearly shows, that he was aware even of the existence of such 
a quality in disease as contagion.* 

In regard to the description given by Thucydides of the 
plague at Athens, in the Peloponnesian war, I must observe, 
that whatever its merits may be in other respects, it is too 
vague and inaccurate for any medical purpose; for it does not 
unequivocally designate any known disease. The parts of it 

* Galen was manifestly convinced of the contagious quality of the plague when he 
used these expressions, (rvihxTgiQetv to7<; ^ot/u-eirTovTiv tTtcrQcthiq, onrobuvnti 
yk$ tttv^vvoq, a<T7reg i^agces rivbs t}" o(p6xXu.isi<; Lib. I.e. 2. de Different. Fe- 
brium. The last observation respecting the contagion of Opthalmia is become remark- 
able, since this quality has been ascertained to exist, in that species of it which has been 
imported from Egypt. Galen morever acknowledges that he left Rome and returned 
to his own countiy (Pergamus) to avoid the contagion of plague. Jlristotle also believ- 
ed the plague to be contagious ; for he asks. 

Prob. Sect. I. prob. 7. &t& Tin-ore o Ae/ftos jttovjj ruv voo*m pu^teec rove, 
5rAijG-<«5flVTas Tt "S 6e^et,7f£VOfJLt)iot<; 7rgoo-otwirtiu,7r>WG*iv. v> ort /lcovh rcilv vocat* 
xoivrf *V/v ofsrectrt wee £tcc rouro woto-tv Isrt^i^et tov Xoiftov* oorai fictuXati 
f#evTe$ 'x^zrxoyjutri^ x.xi ya(> £tec to vzrex.KXVfAci rtTs voV« TV s ^x^ot toiv 
QegXTrevofAeveM <yivou.h)$s rx^eeog itzro tov zr^otyfixToc, otXta-KOVTctt. Also, 

Probl Sect. VII. 1. Aix, r) xzso fiU voerwv tviojv vo<rou<riv oi 7rto(riei£ovTt<; 9 
a-&o &e iytsixs ohfot$ oytx^eTxt ; which is a plain mention of contagion, though 
not applied to any particular disease. 

Aretseus, in the last chapter of his second Book of Therapeutics, observes, that ele- 
phantiasis is as contagious as plague. 

" Atos *Jf %vf4.GioZf Tt y xui %vvfootiT«$ai, t>v #te#v n" telnet, mmn 



376 

most applicable to the plague are the alleged contagious pro- 
perty of the disorder, and the mention of small pustules and 
sores, as marking the bodies of the sick. t>xvy,rxivsi^ ^x^«7? x.ai 
s^Keo-iv e%yv6r,Kos. There is, however, no intimation of any glan- 
dular tumours, which must have occurred in the time plague ; 
and all things considered, the disease seems most likely to 
have been a marsh fever, combined with scurvy, modified and 
aggravated by an accumulation of eight times the usual num- 
ber of inhabitants, afflicted by famine, despair, and all the 
calamities of war. It is remarkable, that the disease began, 
and prevailed most, at those seasons when marsh miasmata 
are always most powerful ; and though said to have been con- 
tagious, it was not communicated even to the neighbouring 
towns of Peloponnesus and Boeotia : a plain indication of its 
having been produced, and propagated by local causes. 

Among the definitions of plague given by nosologists, that 
of Dr. Cullferi* seems to be one of the least objectionable. 
But even this is faulty, by including typhus fever, which pro- 
bably never occurs in this disease, and is as distinct from it, as 
from small pox or measles. It may indeed be possible that a 
person who has been exposed to the contagion, both of plague 
and typhus, should be- attacked by both diseases together ; 
but in this case, the infection of each would doubtless remain 
distinct, and only be able to propagate its peculiar disease ; 
because one is communicable by immediate contact only, and 
the other, so far as we can judge, exclusively through the me- 
ilium of the atmosphere. 

The definition of Pestis, by Sauvage, accords with that of 
Cullen, and is liable to a similar objection. Linnseus. substi- 
tutes a most acute Synocha Typhus fever ; a substitution which 
will often be at variance with fact, as in most cases no such 
fever is present. Vogel errs in a greater degree, by arrang- 
ing plague among simple continued fevers, stating it to be epi- 



* Pestis. " Typhus maxime contagiosa, cum summa debilitate." — " Incerto morbl 
die eruptio Bubonum vel Anthracum." 



377 

demic and most acute ; and superadding a great number of 
symptoms, neither essential nor constant to the disease. Sa- 
gar's definition is less exceptionable than Vogel's, but it is at 
least objectionable, as including typhus fever. 

Orraeus, who Was sent with superior medical authority, 
by the late empress, Catharine of Russia, to advise and assist 
during the plagues at Jassia (or Yassy) and Moscow, has re- 
fused to admit fever of any kind among the characteristic dis- 
tinctions of plague ; and assigns his reasons for doing so, at 
pages 71, 2, and 3, of his Descriptio Pestis, (4°, printed at 
Petersburgh, 1784,) where, though he acknowledges that feb- 
rile symptoms occur in most cases of plague, he maintains, 
that fever does not essentially belong to the disease, nor con- 
stantly attend it. And that it would be just as reasonable to 
give the name of fever to that acceleration of pulse, and other 
effects of morbid excitement, occasioned by acrid poisons, 
fumes pP charcoal, &c. as to the febrile symptoms which often 
attend the plague. And certainly fever, properly so called, 
does not constitute the disease, nor is it in all cases percepti- 
ble, even as a symptom;* but the latter part of this observa- 

* In very mild cases of plague, buboes arise and suppurate or disperse, and the 
disease terminates without any manifest febrile symptom. I saw some such cases, 
in the pest-houses at Aboukir, in 1801, and a greater number have been observed by 
others in different situations. The like happens sometimes in the mildest cases of 
inoculated small-pox ; on the other hand, I believe (though such cases did not fall 
under my observation) that the morbid impressions from the contagion of plague are 
sometimes so powerful as to extinguish life, before any such reaction of the system 
can take place, as would produce an appearance of fever. In general however, and 
excepting these extreme cases, there is so much of reaction, or of effort, bv what has 
been called the vis medicatrix naturae, that febrile symptoms, more or less violent, 
as well as variously modified, do (as in small pox) occur to persons attacked by the 
plague, during a part of its continuance. See Waleschmidt d^ sig. Pest. Holsat. 1712. 
Haller (Disp. ad morb. Hist, et Curat, v. 5. p. 555.) " Pestis, proprii loquendo febris 
vocari nequit ; est enim ssepissime sine febre, et sub varia larva sua ludit dra- 
mata." 

Diemerbroek observes (de peste, p. 12) " Pestis sins febre paucis incipiebant et 
finitur; pluribus sine febre quidem ineipiebat, sed quae ta-nsn non diu post insequeba- 
tur," &c He adds, in a note, " Pestem esse quid diversum a febre, et febrem ejus 
esse symptoma, durante hac pestilente constitutione multoties observavimus^ ac 

48 



378 

tion would apply to every other symptom of the disease, no 
one of which invariably and manifestly occurs to every pa- 
tient ; so that if, in defining the plague, we were to reject all 
the symptoms which are not constant and inseparable, we 
should have none left to denote the disease ; fever, therefore, 
though of no particular form or species, may perhaps be ad- 
mitted as part of the definition, and this with a swelling of 
some of the lymphatic glands, or with exanthema, including 
carbuncles, may serve generally to designate the plague, if 
accompanied by that particular contagion which is its cause 
and essence, and witlimit which there can be no plague. 

The limits prescribed for this publication, will not allow me 
to describe the several forms, modifications, and degrees of 
fever which accompany the plague in different seasons, situa- 
tions, and individuals. They arc in fart as numerous and va- 
rious as the human constitution is capable of exhibiting. In 
the young, robust, and plethoric, we find sy nucha, or ardent 
fever, with the usual inflammatory appearances, and in 
feeble or debilitated constitutions we ha\c the appearance 
of low nervous fever. The intermediate degrees and com- 
binations are, however, much more frequent than either of 
these extremes \ indeed, the cases of ardent fever com- 
monly bear a very small proportion to the others, perhaps 
because the action of this contagion is found generally to de- 
press or diminish the living power. In all tin - the 
patient's constitution and circumstances have a great, if not an 
exclusive influence upon the febrile and other symptoms : 
with this exception, however, that in persons who have pre- 
viously been sufficiently exp o s ed to marsh eilluvia. the ! 
to which this contagion acts as an exciting cause, generally 

proinile nonnulli pestem male per febu m defimuut, cum febris uon sit de ip 
ut infra probabitureap. \1 

Dr. Sotiia, at p. 3. of his Memoir 
the varieties of thai % u Finale ment, il yen avait quelques-uns atl 

d'unlegermal i!c t«:e, avec uo 
tement sous I'aine, a leu rou ■« i h- bub >.\ pestH 
hubon se prononcait, pour 



379 

takes on the form either of a quotidian intermittent, or of a 
double tertian."* 

I have assumed this disease to be essentially and specifically 
contagions, and I shall presently mention sufficient proofs and 
grounds for the assumption. But I think it expedient first to 
offer some observations, concerning the channels through 
which its contagion is received by the human body ; because 
the production of buboes, in my opinion, depends entirely on 
this fact, that the contagion after being applied by contact to 
the skin, is exclusively received through it 9 and conveyed by 
the lymphatics into the blood vessels,! as in tne casc of inocu- 



* Dr. Price informed me that in all or nearly all the Sepoys or other East Indians 
lttackcd by the plague, who had fallen under his care in Egypt, the accompanying 
fever was of the intermitting form ; that the paroxysm began with cold and shivering; 
and it was during the cold stage that most of these blacks died. They had probably 
all been exposed to marsh miasmata, in the neighbourhood of Rosetta ; and to 
this circumstance I should ascribe the occurrence of this form of fever among 
them. 

■j" The facts which prove the necessity of actual contact with some infected person 
or thing to communicate the plague, are so numerous, and many of them so notorious 
that it must be unnecessary for me to enter upon a detail of them, after what Dr. Ilus- 
sel and others have published, and after the experience of the British army in Egypt, 
which invariably demonstrated this necessity, by shewing that all those who avoided 
contact invariably escaped the disease, whilst those who did otherwise in suitable condi- 
tions, were very generally infected. Nor vug there, so far as I have been able to dis- 
cover, any instance, in the French Egyptian army, of a communication of the disease 
without contact, though the Physicians to that army, who have written on the subject, 
do not, I believe positively assert the impossibility of such communication. Hut M. 
Desgenettes, the chief Physician to that armv, at p. 248, when writing upon this con- 
tagion, says, " on a vu un simple fosse, fait en avant dhtn camp, en avreter les ravages ,■ 
et e'est sur des observations de ce genre, que est fonde Visolement avantageux des 
Francs, dont la pratique a ete suffisamment, detaillee par divers voyageurs." And Dr. 
Pugnet, one of the physicians of the same army, (whose experience in this disease was 
very extensive) at p. 130 of his Memoires, sur les Fievers Pestilentiellcs, fee. du Le- 
vant, not only supposes the necessity of contact, but adds that even this will not suffice 
without an aptitude in the receiver of the contagion. He indeed afterwards intimates, 
that from the crowded and confused state of the armv, he had not been able to asvcruiin 
" si le contact de la personne malade, ou de ce qu'tf a touche est indispensable, pony,] 
donncr la maladie," &c. It is apparent, however, that he did not know of any other 
way in which the disease had been communicated ; and the physicians employed at 
Moscow, during the plague, which destroyed nearly 60,000 inhabitants of that city, in 



380 

lation for the small pox ; and hence we may account for the 
morbid state of the lymphatic system, which has been ob- 
served, in the few cases of dissection, where proper attention 
was paid to its condition. The effects of morbid poisons, and 
other noxious matters when absorbed, upon the glands con- 
nected with the absorbents, have been sufficiently manifested ; 
and it is from this cause that the axillary glands of one or 
both arms, when the small pox lias been introduced by inocula- 
tion, become swelled about the time or a little before the com- 
mencement of the eruptive fever; and (as is well known) it is 
also by an absorption of venereal poison, through a particu- 
lar organ, that the inguinal glands, to which that poison is 
directly conveyed by the absorbents, become affected ; and it 
is because the contagion of plague is not commonly applied 
and communicated through the same organ, that pestilential 
buboes near the groin arc not often, if ever, formed in the 
very same glands as the venereal, but in the femoral and 

1771, appear, by abundant experience, to have left no room for doubt on the subject. — 
Dr. de Mertens, in the English translation of his account of that calamity, says, ■ the 
contagion was communicated solely by contact of the sick, or infected goods." " It was 
not propagated by the atmosphere." lie adds, « when we visited any of the sick we 
went so near thorn that frequently there was not more Uian a foot distance l> 
them and us ; and though we nsed no other precaution than that of not touching their 
bodies, clothes, «r beds, we escaped infection." M. Samoi'lowitz, who was surgeon to 
the great military hospital, where tin plague in question first appeared, and who be- 
sides the most extensive experieuee in Moscow, had been greatly employed for that 
disease, in Poland, Moldavia, and Wallachia, asserts, in the preface to his " Memoire 
sur la Peate,"ftcc that " il est certain que la poste ne se develloppe, et ne se pro page 
que par le contact ainsi que je le demon t re dans mon memorie;" which indeed 
he afterwards does, by numerous facts Rut after all these observations, I would 
not be understood as maintaining that the air expired from the lungs of a pa- 
tient under the plague, and loaded with humidity, may not contain some 
contagious matter, capable, if immediately received into the month ami lungs of 
another season (by a very near approach of their faces to each other) of being absor- 
bed, and taken up by the lymphatics spread over these internal surfaces, or perhaps 
by the lungs, so as to produce the disease : This would, 1 think, be nearly equ 
to contact, and attended with no more difficulty than there is in an absorption bv the 
skin. Orrssua says, p. 151, " commwu'ssima aflVctionis via per cmtta 
lie thinks, however, that the disease ma\ be token by the breath ; but if this were true, 
the other would not be the most common way, because people frequently can and do avoid 
contact but cannot avoid breathing w ith the sick. 



381 

other glands which are connected with the lymphatics coming 
from the lower extremities. Orrseus, indeed, mentions a fact, 
which, without his appearing to be sensible of it, demon- 
strates the production of pestilential buboes by absorption. 
He says, p. 154, " In quibus escharse carbunculorum, post 
superatam pestem acutam, diutius neglectse restitarunt, partes 
adjacentes valde intumuerunt, et in non nullis bubones de 
novo suscitabuntur." These secondary, or new buboes, 
could only be caused by an absorption from the protracted 
and neglected carbuncles.^ 

While the lymphatic system and its uses were but very lit- 
tle known, and pestilential buboes were considered as an 
effect of the vis medicatrix naturae, and as being intended to 
facilitate a critical separation and discharge of the pestilen- 
tial virus from the blood, we need not wonder that a morbid 
absorption was not suspected to have been their cause. But 
it seems extraordinary that in recent times, and with modern 
discoveries, not only Samoilowitz should suppose buboes to be 
formed by the contagion of the plague thrown outwardly from 
the blood, (See his Memoire, p. 112,) but that a similar 
opinion should have seemingly been entertained by M. Desge- 
nettes, the chief physician of the French army in Egypt. I 
conclude at least that this must have been his opinion, because 
he states buboes to have been produced by an inverted action 



* Platerus had also observed the production of buboes, by the influence of carbun- 
cles, though he probably did not suspect the way by which that influence was exerted. 
He says (Praxeos Medicoe, t. ii. p. 79) " Sed et fit ut bubones in peste correptis, non 
semper, a venenata ilia vi" (veneni pestiferi) "in corporis emunctoria excussa, verum 
oh carbonis vicini ardorem doloremque influxum hunc in adenes eommoventis, uti in 
aliis quoque inflamationibus accidit proveniant." He afterwards mentions the forma- 
tion of carbuncles, particularly in pestilential fevers ; adding, " a quo anthrace ab in- 
itio lineam rubram ad bubonem, qui plerumque ilium comitari solet" " porrigi ssepc 
observavimus." The red lines here mentioned are now known to proceed from 
an inflammation of the absorbents ; and they were observed, even by Galen ; see the 
note to page 556. He adds, concerning these buboes, "cernitur autem aliquando 
ipsa quo que vena per totum membrum rubra et calens, et distenta." &c. But 
though secondary buboes may be produced by an absorption from carbuncles, the 
latter can never produce them on patients in whom carbuncles do not occur, or only 
occur subsequently to the buboes, as is often the case. 



382 

of the absorbent system,* contrary to every thing analogous 
with which I am acquainted. And in the very next paragraph, 
after mentioning carbuncles as being eminently contagions, he 
says (that in opposition to buboes) they are produced by di- 
rect absorption : — " par absorption directe, e'est a dire dans 
J'ordrc ordinaire, et par la voic la plus courte, et le pins sim- 
ple contact.- 9 To me, however, it seems most probable, that if 
either buboes or carbuncles result from any thing thrown out- 
wardly by arterial action, or by any effort of nature, it must 
be the latter, rather than the former, which are so produced. 
I have insisted the more on this subject, because the truth 
concerning it seems to be of some importance in regard to the 
prognosis, as well as treatment of the disease. 

Dr. Price informed me that in all the bodies of persons 
who had died of plague, which he dissected in Egypt, the 
glandular system was morbidly affected :f and Dr. Sotira, 
who was physician to the French army there, observes, that 
according to his information, those who died of that disease, 
and had been examined by the French medical officers, besides 
a morbid state of the brain and spinal marrow, were found to 
have " tout le systeme des glandes lymphatiques engorge/' 
See Mcmoire sur la Pestc Observee en Egypt, fcc.*' p. 8. 

With these, and other proofs of morbid absorption by the 
lymphatics, it is not surprising that buboes should be the. 
most frequent of all the symptoms which occur in this multi- 
form disease. On a general computation, I think it would ap- 
pear that glandular swellings have been observed in nearly 
three-fourths of those who were supposed to have had plague, 

* " Los hubons pestilemiels sont des engorgements des glandes lymphatiq' 
s opcrent evideroeat par un mouvement inverse du systeme absorbant." Hi 
dicale de L'arniee d'Orient, p. 109. 

f Dr. Price informed me, also, that in all the bodies which be had dissected, the 
liver was greatly enlarged: but these, excepting one, had all been born in the East 
Indies ; and on my asking, whether he did not think it more likely that an affection of 
that viscus should have existed previous to the attact of plague, than that such enlarge- 
ments should have been so suddenly produced by that disease, he answered ■ 
formative. 



38S 

ami many are erroneously supposed to have had it, when it 
prevails extensively and destructively, and as no sufficient 
examination takes place in many of the more violent cases, 
where buboes often do not appear till the approach of death ; 
and there are others, where the rudiments, or germs, are dis- 
coverable only after death, and by such applications of the 
fingers as are both dangerous and unpleasant, it may be in- 
ferred, that but very few if any persons have undergone this 
disease, who either had not glandular swellings, or in whom 
they would not have occurred, if life had not been extinguish- 
ed, before there was sufficient time and reaction of the sys- 
tem for their production. I do not, however, think it im- 
possible that so much of the contagion of the plague as will 
suffice to produce the disease, should find its way into the 
system by the absorbents, without producing a swelling of 
the glands, though facts prove that this does not commonly 
happen. Whether in any of those mild cases, where buboes 
have appeared without fever, and which have been supposed 
to be most liable to re-infection, the contagion had affected the 
glands, without finding its way into the blood vessels, I am 
unable to determine. I am also unable to explain why the 
fermoral or inguinal glands, should he much oftener affected 
than those of the axilla ; a fact which has been generally ob- 
served, and which seems to make it probable, that the conta- 
gion of the plague has been more frequently taken up by the 
absorbents of the lower extremities, than by those of the 
hands and arms. This might well be the case with persons, 
who, like the inferior inhabitants of warm countries, seldom 
wear shoes and stockings , but there is some difficulty in un- 
derstanding how it could happen to others, unless stockings 
by absorbing and retaining the contagion, favour, rather than 
obstruct, its approach to the skin. 

When the disease is likely to prove mild, its commence- 
ment is commonly first indicated by hardness of the glands, 
and in many cases this occurs with, or soon after, the first 
febrile or olher morbid symptom : often, however, and espe- 



384 



cially in cases of great debility, no glandular affection is dis- 
coverable for several days, nor even until the near approach 
of death. So much has been written by various authors (and 
particularly Orrseus, at p. 95 and 6,) in regard to buboes, 
their appearances, situations,* numbers, sizes, &c. that as I 
am not giving a treatise of plague, I may be allowed to pass 
over these topics. 

For similar reasons, I shall offer very few observations re- 
specting the anthrax or carbuncle, of which Omeiis seems to 
have given the best account. f Their occurrence is, I believe, 

• " Des qu'un bubon pai-ait soit aux aloes oc ail; ce tousjour? 

dcssus ou au-desous de la gtande et jamais but la g comme les bubons ven« 

criens. Ceux des aiues prominent ordinairemeiit deux dnigts au-dcssous des glandes 
inguinales." Memoires ur la Peste, par M. D. SonoilowRz, M. D. kc. p 1 

•(■ Orncus p. 90. " Carbuneuli nihil aliud sunt quam sideratione* pai tiales cuti* t et 
fi'proximx cellulose" (membransc) " anigredine cm naneup^ti." 

lie makes a distinction of carbuncles into the moist and dry, wh'.ch I do not recol- 
lect to have been made by any other writer, though it appears a rery pi-oper and nc- 
ccssaiy one. The former is that which seems to agree best with what authors have 
described as the pestilential carbuncle. Orraeus describes it thus: — " Febre p 
tiali jam oborta, vel interdum simul cum cd, pars qualiscunqve corporis, nunc URJD» 
ris, nunc minoris ambitus ardere, dolere, rubescere, et tumescere incipit : (in aliis non 
nisi macula rubra, vix supra superjiciem cutis prominens, conspicitur,) non diu post, in 
medio tumoris una vel plures, hand procul a se invicem dUtantes pustule, quasi 
capitnla acuum," (pins' heads) " maju-scula, altitudinem lines," (1-12 of an inch) 
" nro superantes, pallidiusculae & sanie turbida replete exsurgunt, quae post breve 
intervallum crepant ; cutis vero subjects livescens k mox ingrescens sphacelum jam 
factum indigitat Nigrities hxc paulatim in omnes dimensiones ulterius serpit, cum 
peripheria semper inflamnaata. Sccpe ex carbunculo in variam directionem pi ■ 
ad tractum majorum vasorum &: tendinum, vibices s&t insignes protenduntur. "' Samoilow- 
itz (p. 142) says, that the only parts in which the* carbuncles do not happen are ■ les 
parties recouvertes de pods, ainsi que celles ou se manifestent les bubons. " He is pro- 
bably wrrniff with respect to die latter for Orr*us (p. 98) says, that sometimes 
the moist carbuncle " bubonibus im plan tat ur ;" Samoilowitz is incorrect, too, 
as to the progress of the carbuncle; for after saying, (p 145) that "les po 
eprouvent deja une douleur ties vive a Vendroit ou ils doivent se placer 
mentions, that **il (nut ausi tot visiter I'endroit qu*il indique. Ony trouvera (Tabard 
im tres petit bubon, ou pustule rempli d'une serosite jaunatre, sans ouatn 
signe* d s infianvnation." Now this is what I believe never takes place, for 
the excessive pain felt at the part is only the ry considerable 

mation existing in it, which usually arises to such a degree of violence, as at last 
to destroy the vitality of the part : this progress, too, through nhe various de- 
grees of inflammation and mortification is in the moist bubo by no mean? i 



385 

totally unconnected with that of buboes, — I mean that buboes 
have no influence on their production. When they appear 
very early, they assume a dark brown or black colour, and 
remain forty-eight hours or more, without being circum- 
scribed by an inflamed margin ; they generally indicate the 
greatest danger. 

Exanthemata are of several species : — one is a vescicular 
eruption, sometimes of the size of a pea, or larger, appear- 
ing without any determinate situation, of a yellowish or li- 
vid colour, and with an inflamed margin ; they were formerly 
known to the people of England by the name of Mains : when 
three or four of them arise near to each other, they often be- 
come confluent, and, by uniting, produce what Orraus calls a 
dry carbuncle, to which from the first they have great aflini- 
ty ; those which are of a livid colour, flabby, and confluent, 
may be considered as a very unfavourable symptom. 

Another exanthematous eruption attending the plague, may 
be considered as petechial ; it renders the skin spotted, and 
assumes different colours, sometimes reddish, but it more fre- 
quently approaches to blue, purple,, or brown. The dark co- 
loured spots were in this country called, and deemed to be, 
tokens or signs of death, and found to be such in Egypt 

commonly supposed ; for the inflammation of the carbuncle may proceed to a cer- 
tain height, and then stop before any mortification has begun, and this after the 
inflammation has existed for a day or two. Thus Orrseus (p. 112) " Quam pri- 
raum febris" (accompanying the plague,) "funditus sublata fuerit, rudimentum car- 
bunculi inflammatum dissipatur ; interdum (uti in me ipso accidit) humor purulen- 
tus quasi sub vesiculd grandiori derepente obortd colligitur, & evacuatione per iocisi- 
onem facta, fundus cutis mberrimus, St minime sideratus per suppurationem levio- 
nem sanationem facile admittit." 

The dry carbuncle (says Orrseus p. 97) " e contra sine ullis inflammationis indiciis 
e maculis" (petechiis) " latioribus coiifluentibus enascitur t quse scepe ante febrem 
aderant : hac vero" (febre) "jam accensd, cutis nigerrima facta arescit, corrugaur, 
et • . . . vicina depascitur ;" rtibor « marginis" " fere nullus est." He adds. " Per- 
iculossisimus est & vix multi eo affecti ex naufragio vitae emergunt, dum exhunudo'* 
.... " maxima segrotorum pars convalescit, nisi in partibus nobilioribus . . . locatus 
fuerit," 8cc. or unless it shall grow to a vast size, and produce suffocation, or exhaust 
the patient's strength. This dry carbuncle is not very painful. 

49 



386 

These petechial spots do not change their form or character 
like the vesicular eruptions. Orrseus mentions, at p. 113, a 
case in which these spots made their first appearance in great 
numbers, immediately after death. 

Of the contagious nature of the plague, I should hardly 
have thought it necessary to adduce any proofs, after all that 
has been experienced, and written of its dreadful effects, had 
it not lately become fashionable to entertain doubts, at 1« 
on the subject, without any other foundation or reason, so far 
as I can discover, hut that of the escapes of persons who 
sometimes are seemingly exposed to this contagion, suffici- 
ently for the production of disease. I have certain h 
been inattentive to facts of this nature, nor unwilling to al- 
low them their full force : and the opinions and modes of 
reasoning, which I have entertained in regard to yellow fe- 
ver, have led me to endeavour, as far as possible, to a- 
tain how far the multitudes of opposite facts could be explain- 
ed, by supposing the operation of any local or atmospheri- 
cal cause, distinct from personal contagion, and particular!} 
that of marsh miasmata, to which plague has recently been 
ascribed by writers whose opinions are justly of great weight : 
I have however, found insuperable difficulties in the \va\ of 
every supposition which does not admit the influence of a spe- 
cific contagion. 

\l hen I took charge of the pest houses at Aboukir, in 
1801, Dr. Buchan. my predecessor, and every other medical 
officer employed in that dangerous service, had already caught 
the disease : and of these officers, twelve in number, seven 
had died, besides a considerable number of nurses, and other 
attendants on the sick ; though if there be any spot on earth 
exempt from the operation of marsh miasmata, it would. I 
think, have been that upon which these pest houses were pla- 
ced, together with the surrounding dry, barren sands, within 
which, those who took the plague in this manner, had in 
effect been confined. The cause which had thus created a 
specific disease in every medical officer exposed to its action. 



387 

must have been peculiar and powerful, and there was not 
the smallest reason to suspect the presence of any morbid 
influence, except that of pestilential contagion, nor could 
marsh effluvia, had they been present, have occasioned such 
a disease,* nor, indeed, could any tiling else within our 
knowledge, other than its own specific contagion. 

Tire medical officers of the French army had previously 
experienced the effects of this contagion to a much greater 
extent. Dr. Sotira, one of its physicians, after expressing 
his astonishment that there should be men M assez bizarres 
pour ne pas croire a la contagion de la peste," among other 
proofs of its possessing that property, mentions the loss which 
was sustained from this disease by that army in the seventh 
year of what was called the French Republic, " d'environ 
quatre vignts oiiiciers de saute" of about eighty medical offi- 



* There aVe many irresistible proofs, that the cause of plague is perfectly distinct 
and unconnected with that o! yellow, and other marsh fevers. Were it the same, we 
should certainl) find the former disease most prevalent between the tropics, instead of 
being, as it notoriously is, totally excluded from so great a part of the globe ; and we 
certainly should not find its progress suspended in Egypt during the hottest months, 
when marsh miasmata are most active and powerful ; nor should we find the natives 
of Africa and of the East Indies, who are least susceptible of morbid impressions from 
tl/ie latter, and in whom marsh fevers, when they do occur, are mildest, not only ta- 
king the plague frecmently, but dying of it in far greater proportion than any other 
race of men ; as was found to be the case by the British East Indian army in Egypt, and 
as Desgenettes, Fugnet, Sotira, and the other French physicians, declare to have hap- 
pened to the negroes who fell under their observation Dr. Sotira, indeed, asserts, 
that all of them who had the disease died of it very soon. The circumstances which in- 
fluence the production of marsh miasmata appear to have no share in causing the 
plague ; its ravages being as great in the high, arid and barren parts of Syria, as among 
the canals, and upon the rich soil, of Lower Egypt ; and indeed, it prevails least in 
those parts of Lower Egypt which are most productive of marsh effluvia ; and particular- 
ly the Delta. I have said nothing of the very important and essential differences which 
must always subsist between the plague and yellow fever, notwithstanding all the inge- 
nuity and labor which have been employed to give them an apparent similitude. Nor 
have I noticed the certainty with which the Franks secure themselves from plague by 
shutting up, provided the known precautions are not neglected or transgressed, as 
sometimes happ-ns. Would sueh precautions exclude marsh miasmata, or would a 
ditch ward off their morbid influence, and as Desgenettes asserts, have secured an 
army from the plague ? 



388 

cers ; a loss which, he says, was the more deplorable, because 
it could not be repaired. He adds, that in the two fallowing 
years, it was thought expedient to employ Turkish barbers, to 
dress buboes, carbuncles, and blisters, as well as to bleed and 
apply frictions of oil, under the inspection of French physici- 
ans and surgeons, and that by these means only twelve medi- 
cal officers died in twice the former space of time.* As the 
deaths of the first year afforded a strong proof of contagion in 
the disease, their great subsequent diminution manifested the 
probability of escaping it, by abstaining from the actual contact 
of infected persons and tilings. 

When the plague re-appeared in the British Indian army, 
during the autumn of 1801, and the succeeding winter, more 
precautions were used by the medical officers employed in the 
pest houses, to guard against contagion, and a greater pro- 
porti< n of them escaped : but still a majority of these gentle- 
men took the disease, and to more than half of them it proved 
fatal. I could fill volumes with valid and well-attested proofs 
of the contagious nature of plague. But I must refer those 
who may entertain doubts on this subject to the facts publish- 
ed by the French physicians who were in Egypt, and by 
Orraeus, Samoilowitz,* and others, who saw the plague in 
Russia, Moldavia, Wallachia, Poland, &c. 

• See Memoire sur la Peste obscrvee en Kgypte, &c par Gaetan Sotira, Docteu 
en Medecine, Medecin de I'Arme d' Orient, &c. p. 5. He also mentons, that more 
thai-, half of the Turks, who were thus employed to asist the French surgeons, took 
Uie plague, which in several instances proved mortal ; though mong a considerable 
number of other Turks employed at Rosetta by the French, to bury the dead, only 
one caught Uie disease. This is one of the many facts which indicate that there is 
much greater danger in handling the bodies of infected persons whilst alive t than 
after death. 

f l)r Samoilowitz, who for many years officiated as an army surgeon in places 
wheie he had nun eious opportunities ot seeing persons under the plague, and who 
when that dvea.-e was so destructive at Moscow, in 1771, was most extensively em- 
ployed there, has filled nearly one hundred pages, in Uie early part of his volume 
u Svr fa Peste." with proofs of its contagious influence ; and, among these, he men- 
tions that hiving successively volunteered his services as chief surgeon, in thereof 
the principal hospitals at Moscow all Uie assistant surgeons who were employed under 



389 

Though nearly two thousand deaths, hy plague, occurred to 
the French army whilst in Egypt, it was thought expedient, 
for a time, to deny the existence of the disease ; and both the 
general, Buonaparte, and the chief physician, Desgenettes, 
exposed themselves to some dangers, in order to allay the 
general apprehensions of the soldiers on this subject;! ana * 
among other expedients, the latter, after dipping the point 
of a lancet in the pus of a bubo, on one of the convalescents, 
slightly pricked his groin and his arm, near the axilla, taking 
care, however, to wash himself immediately with soap and 
water, which, as he says, were brought him for that purpose ; 
a small inflammation was produced in the spots which had 
been thus pricked, which lasted three weeks, but produced no 
worse consequence. Whether the disease of the convalescent, 
from whom the pus was taken, had passed beyond the stage in 
which it is contagious, as is probable, or whether the pus was 
applied in too small quantity, or washed off too soon, I will not 
decide. Desgenettes, indeed, acknowledges,( p. 89) that this ex- 

him, fifteen in number, took the disease, and of these all died, excepting three ; whilst 
the physicians who walked among the sick, but carefully avoided all contact with them 
or their clothes, &c. generally escaped. 

Samoilowitz was himself three times attacked by the disease, a circumstance 
which he ascribes to the dispersion of his buboes without suppuration, the first and se- 
cond times. — See p 39, 40, &c. also p. 35. 

DrTPugnet, among other instauces of pestilential contagion, says, "Huit Francais 
a Caipha, se sont successivement communique le gerrne de cette maladie, en se trau 
mettant une pelisse ; cinq sur six, a Gaza, en se disputant un habit de drap, la de- 
pouille d'un de leurs compatriotes ; quatre a Jaffa en mettant a leur usage des mou- 
choirs de Col qu' un Pharmacien de troisieme classe, mort, avait apporte d'ltalie. Ces 
quatres heritiers, furent en meme temps, atteints de bnbons a V entour du Col et 
perient du troisieme au sixie'me jour.''' See p. 229, 230. These four instances of 
persons becoming infected by tying round their necks handkerchiefs which had im- 
bibed the contagion, and all getting buboes round t/ie neck, are strong proofs of the 
production of glandular swellings hy absorption through' the lymphaties, leading 
to the glands which thus become affected, as I have lately mentioned. 

f Desgenettes, as an explanation of the motive by which he was actuated in regard 
to the plague on this occasion, and also in refusing ever to give that name to the dis- 
ease, says, " Je crus devoir dans cette circonstance traiter Farmee entiere comme un 
malade, qu'il est presque toujours inutile and souvent fort dangereux, d' eclairer sat 

maladie, quand elle est tres critique." 



390 

pertinent proves nothing against the transmission of contagion, 
which, says he, lias been demonstrated by a thousand examples. 
" Ellc n' infirme point la transmission de la contagion, de- 
montrte par mille exemples ; ille fait voir settlement que les 
conditions ncccssaires pour qn' elle ait lieu, ne sont pas hien 
determinees." Whether Dr. White, who entered the pest 
house of the Indian army, at El Hammed, early in January. 
1802, was misled hy this experiment, I know not : but, from 
a persuasion that the plague was not contagious, he immedi- 
ately rubbed some pus, taken from a pestilential bubo, upon 
the inside of his left thigh, and the next morning inoculated 
himself in the wrist, with matter running from another bubo. 
"Four days, however, had scarcely elapsed from his entering 
the pest house, before lie a I xsit'i BhiveHngS, folk 

by febrile heat, k(\ which he flattered himself would prn- 
he an intermittent. lint he died of the plague before the end 
of the third day: and thus, unfortunately, added another to 
the proofs — alas! too many — of the contagious nature of this 
terrible disease. 

We probably do not know so much of the facts and circum- 
stances which either favour or retard the transmission of | 
lential contagion from an infected person (or thing 
who are uninfected, as would enable us, in all ca- 
the true cause, why persons often cscai>e harmless, whom 
posure to contagion has seemingly been such it to have 

subjected them to the disease : much seems to depend on the un- 
fitness of the atmosphere to become a vehicle of this contagion, 
and on the necessity of an actual application of it to the human 
body, and of a subsequent absorption through the skin, all 
which must render its introduction into the system more diffi- 
cult and precarious. Volatile contagions, particularly i 
of small pox and measles, will necessarily be taken into the 
lungs of one who breathes the air in which they are diffused : 
and the lungs, being peculiarly fitted to imbibe a vital part 
from the inspired air. they, in doing this, nun probably imbibe 
contagion also; and therefore we might naturally expect. 



391 

what seems to happen, that persons who have never been at- 
tacked by these diseases should seldom escape, when suffici- 
ently exposed to their contagion : whilst, on the o+her hand, 
we find that those morbid poisons which being fixed, can only 
be received by contact, through the skin, very often fail in 
producing their effect ; this is particularly true of the virus of 
rabid animals, that of syphilis, &c. which are not always of 
the same force, nor are the absorbents equally disposed to re- 
ceive them in all men, nor at all times even in the same man. 
Dr. Pugnet, though he is justly convinced that nothing will 
produce the plague but its peculiar contagion, thinks the suscep- 
tibility of the human body for it is greatly increased by a moist 
and moderately warm atmosphere — that children, females, and 
persons of delicate, feeble constitutions, are most apt to become 
infected ; and that those who are naturally robust and vigor- 
ous seldom take the disease, unless weakened by excessive fa- 
tigue, or by excessive indulgence with women, or intoxicating 
drinks. See p. 205. Dr. Sotira entertains nearly the same 
opinion. Desgenettes remarks, p. 248, that the plague seem- 
ed more particularly to attack those who were exposed to sud- 
den transitions from a hot to a cold atmosphere, and vice ver- 
sa : such as bakers, cooks, and blacksmiths ; and that men 
addicted to excesses with women, and spirituous liquors, ve- 
ry seldom recovered from the disease. 

It has been supposed by Omeus, Pugnet, and others, with 
some probability, that abundant transpiration through the 
skin, may hinder the absorption of pestilential contagion, and 
even wash it outward from the pores ;* and on this supposi- 
tion, the former has strongly recommended the taking of exer- 
cise sufficient to produce a copious discharge of sweat, after a 
real or supposed exposure to the contagion \ — and it seems to 



* If the contagion of plague be thus washed outward upon the skin, might it not 
descend to the legs or thighs, ai.d after the sweating has ceased, be there taken up by 
the absorbents, and in this way, render inguinal, femoral, or crural buboes more frcr 
^uent than those in the upper parts of the body f 



392 

have been on this supposition, that Desgenettes, alter his 
its to the pest houses, always mounted his horse, and rode un- 
til he found himself in a free prespiration. Seep. 90. 

Another probable cause of unexpected escapes from pesti- 
lential contagion may be the short time which persons under 
the disease continue in an infectious state. Our knowledge 
on this subject is very deficient. It has been ascertained that 
variolous patients do not infect others, at soonest, until their 
pustules begin to maturate, and they are probably most infec- 
tious when these are in a state of desquammation ; v\hiKt 
persons who have the measles, to my knowledge, have com- 
municated the disease before any eruption was discoverable. 
It has not, however, been sufficiently ascertained when pati 
under plague Irat acquire the power of infecting others, nor 
to what stage of the diae a o c they retain this power. I was 
confidentially informed, when at Aboukir, of an instance in 
which no infection resulted from a most intimate connexion 
with a female, a single hour before she was attacked by the 
plague. Dr. Sotira thinks the disease is most, if not exclu- 
sively, communicable during the rxisience of foyer; and 
Pugnet thinks the disease Ceases to be conti so soon as 

the fever terminates.* Dr. Desgenettes, in his Resume, p. 
248, says the body whilst warm, and especially in the febrile 
state, seemed to give out contagion most sasitj. Orrscus, 
however, at p. 151, represents the disease ;e> being infec- 
tious only when at its acme : — H Coutagium ab iis solum, qui 
in acme pestis constituti sunt propagari vidctur.'' And by the 
account which Sonini has given of his own case, (See Essais 
Philosophiques, &c. p. 177. and seq.) it seems probable that 
when the disease has so far advanced, as that the buboes sup- 
purate, the body ceases to give out contagion. 



* If the contagion of plague depends exclusively upon the tchnle action which mosi 
frequently accompanies it, those case* of the disease in which there was no ft-Ter, (such 
as that of a cook at the pest houses of Aboukir,) may be supposed to hare been in 
capable of giving the disease to others. 



SOS 

But besides all these impediments to the communication of 
disease by persons ill of the plague, (and which will account 
for many of the supposed extraordinary escapes,) there are 
others arising from the influence of atmospherical heat and 
cold, which, in their extremes, either render the contagion 
dormant* or suspend that susceptibility or affinity of the hu- 
man body, without which it cannot produce disease in ordina- 
ry circumstances. Pestilential contagion probably exists at 
all times in Lower Egypt, Syria, and many of the great 
cities of the Levant, and it is frequent on board Turkish and 
Greek vessels. It appears to have been first introduced into 
the British hospitals at Aboukir, by the carpenter of the 
Dictator, of 64 guns, who was sent in a boat to visit a Greek 
vessel at sea, and thus caught the disease.* This was about 
the beginning of May, and the disease was readily propagat- 
ed, and prevailed with its usual mortality, during the whole 
of that and the following month, after which it was commu- 
nicated with greater difficulty, and when communicated, the 
disease was much milder, though one case fell under my ob- 
servation, towards the end of July, which proved fatal. The 
disease was, however, this year protracted in Egypt several 
weeks beyond the time when it usually disappears, which is 
commonly supposed to be about the 24th of June, the Nativity 
of St John the Baptist, and its cessation at that time, is by 
superstitious christians ascribed to his benignant interference. 
On this occasion the effect of heat in lessening the susceptibi- 
lities of individuals, or their aptitudes for taking the disease, 
was most evident in those who had lately arrived from cold 
climates, and who were comparatively most affected by the 
summer's heat. This was my case, and my escape from the 
disease is ^doubtless attributable to my being in that condition* 
for I employed no unusual precaution, nor ever avoided feel- 
ing the pulse of a patient having the plague, when my doing 
so could be of any benefit. 

* I afterwards discovered the plague on board a. Greek ship employed by the Bri- 
tish government in the Ray of Aboukir, and reported the fact to Lord Keith. 

50 



394 

There were, however, persons in Egypt who had been long 
accustomed to greater degrees of heat, and who were there- 
fore not rendered insusceptible of the disease, and some few of 
these caught it, after it had become extinct in the British 
army, and when a person recently landed from England 
would not receive it, though lie slept in an infected bed: and 
it was from this cause, that in the autumn of the same year, 
the disease began at Rosetta nearly two months before the 
usual time, i. c. on the 13th of September, when I fust dis- 
covered it in two natives of the East Indies, attached to the 
Indian army ; and it was propagated with some rapidity for 
six or eight weeks, among persons who were either born in. or 
had just come from, a climate much hotter than Egypt, whilst 
the British troops directly from England did not receive, and 
probably could not ha\e been made to take the dis< 
These farts are in perfect concord with what I have mention- 
ed of the influence of heat and cold upon the human body, at 
p. 11 :> and seq. It has indeed been alleged, as a reason why 
the plague first appeared in, and was afterwards confined to, 
Rosetta, in the autumn of 1801, that it was the only open 
port to which vessels from Turkey and Greece resorted, and 
that by some of these the disease probably had been imported, 
because it did not, as is pr e ten d ed, occur during the 
ing season at I . or at least that if any case of it did 

occur there; it was concealed. This is. however, certainly 
erroneous; for to my knowledge, several persons at R«>- 
had been attacked by the plague previously to the arrival of 
the Indian army, and had, without any concealment, been 
sent to the pest house near the town. 

It is by this effect of heat, that the plague seldom appears 
in Upper Egypt, and never farther south than the Cataracts, 
(as I was assured by Mr. Brown, the African traveller/ and 
that it ceases earlier at Cairo than at Rosetta. Indeed, it 
this effect which had enabled the Indian army to escape the 
plague until it reached Rosetta. 



395 

The cold in Egypt is never sufficient to stop the progress of 
the plague, and it is therefore commonly most prevalent there 
some weeks hefore and after the vernal equinox : but in Russia 
Poland, and even in Great Britain, the winter has commonly 
produced an almost complete cessation of it. This happened 
to the great plague at Moscow in 1771, though the manner 
and extent in which the houses are there warmed, and the cold 
lir excluded, counteracted the effects of severe frost, so far, 
that some cases of the disease occurred during the whole 
winter. De Mertens tells us, however, that after the month. 
of October, there was a great diminution in the number of at- 
tacks, and of their mortality ; and this is more accurately pro- 
ved, from the statement given by Orrseus at p. 48, by which 
it appears that the deaths in September were 21,404, in Oc- 
tober 17,561, in November 5,235, in December 805, and 
in January 330. Samoilowitz also informs us, that though 
the hospitals then contained many persons who had been newly 
entered for the service of the sick, as barbers, nurses, &c. 
scarcely any of them had the disease after the month of No- 
vember, and never but in its mild forms. Desgenettcs has al- 
so observed of the plague in Egypt, at p. 248, that " les vents 
du nord, lex extremes du froid & du chaud, la font cesser pres- 
que enti erement." 

These facts will enable us, in a great degree, to understand 
why, notwithstanding the contagious nature of the plague, an 
exposure to its contagion is frequently harmless ; and it is for- 
tunate for mankind that divine providence has made its com-* 
munication to depend upon the co-operation of so many fa- 
vourable circumstances, and particularly that of a suitable 
temperature ; that of its application by actual contact proba- 
bly continued for some time ; and that of certain aptitudes 
and susceptibilities in the human subject ; for without such re- 
quisites, or such obstacles to the propagation of this disease, 
the earth might have long since become desolate. 

The contagion of plague, like the poison of rabid animals, 
varies considerably in regard to the interval between its ap* 



396 

plication to the human body, and the manifest production of 
disease : three, four, or five days, seem most commonly to 
intervene. Samo lowitz states the interval between infection 
and sickness, as extending from two to fifteen days inclusive- 
ly ; but in one or two instances which occurred at Aboukir, I 
was inclined to believe that the disease had been produced 
within 24, or at most, 36 hours after the contagion had been 
applied to the body.* 

In regard to the means of obviating the disease, by tl 
who cannot avoid touching infected persons, or garments, kc. 
I have not much to propose. Pugnct says, that in the pi - 
atDamietta, lie used no other precaution than that of immedi- 
ately washing his hands, after they had been applied to an in- 
fected person, or tiling, and taking care that his own clothes 
should not touch those of the sick, or any thing likely to im- 
part contagion : in other respects he breathed the atmosphere 
of the pest houses freely, both with an empty and a full stom- 
ach. Dfgggenettes [». 90) that he lived as well as his 
situation would permit, and used spirituous liquors in small 
quantities at a time : that on leaving the pest houses, lie care- 
fully washed his hands with vinegar and water, or soap and 
water, and gallopedhimw to excite a moisture on his skin : that 
he then changed his linen and clothes entirely, and washed his 
body all over with luke-warni water and vinegar. In addi- 
tion to these precautions, it might, perhaps, he well to ( 
the hands with gloves of oiled silk, or oiled tine linen, or with 
a thin coat of bees-wax, softened by oil, during the tini 
which they are likely to come into contact with the in- 
fected matters. Mr. Baldwin has d, that deaJei 
oil generally escaped the plague : but Orra 
that those whose occupations were much connected with ani- 

• Diemerbrooeck, p. 5-2, col. 1, quotes a passage from Fi-und>ci)i A 
Yhich that author says that he lias frequent!} 

urs after having heen exposed to l aim aliquis 

eorreptum (Jiomineni) pe*te quoquc infiekur, atque p^rtcis ftosf 
i oucklit, quod fieri ssepe vkieiuus." 



397 

nial fats, such as candle and soap makers, curriers, &c. were 
the most liable to be infected. 

When the pestilential contagion has been received into the 
system, it seems in a peculiar degree to exert its morbid influ- 
ence upon the brain and nerves, producing (the slighter cases 
excepted.) shivcrings, tremors of the limbs, and affections of 
the head, such as stupor, vertigo, coma, or delirium, with sud- 
den and excessive prostration of strength, and depression of 
mind ; and it is by this mode of action, that it renders the bo- 
dies of those who die of plague, remarkably soft, flaccid, and 
variously discoloured, witli a permanent flexibility of the 
limbs, as in those who are killed by electricity, or by any 
cause which destroys, or exhausts the excitability or living 
power. The prognosis, therefore, is always unfavourable, in 
proportion as the symptoms denote a greater degree of mor- 
bid affection in the brain and nervous system. 

It is not my intention to enter upon a particular account of 
the various symptoms of plague, for which, indeed, my own, 
observations have been too limited ; but I cannot avoid notic- 
ing that peculiar appearance of the eye, which Dr. Russel 
has called the muddy dull eye, mixed with something (not 
very intelligible) of lustre ; an appearance which bas also been 
noticed by Orra^us, (p. 109) and others, as being peculiar to 
this disease. Dr. Price informed me, that by minute exami- 
nations he had satisfied himself, that this appearance of the 
eye was occasioned by the different colours of the fluids con- 
tained in, and distending the vessels of its external coat, 
which fluids were sometimes bloody, at others yellowish, 
bluish, or dark coloured, and caused the vessels to appear as 
variously shaded streaks, or lines, which sometimes were 
circular, at other times diverging like radii from a centre, and 
in some cases by running together, they produced irregular 
spots, the ultimate effects of all which, he thought, aptly 
enough expressed by the term of a muddy eye. 

Dr. Price also mentioned a peculiar appearance of the 
tongue, which sometimes occurs in this disease, and which 



398 

has "been called the streaked, 01 fery tongue, as produced by 
alternate streaks, or patches of white and red. 

In regard to the proportions of death from plague, it varies 
greatly in different seasons and temperatures ; but I am afraid 
that when the disease prevails extensively, and with its usual 
violence, more than one-half of those attacked by it, have 
commonly died, under the most judicious modes of treatment, 
and with the best accommodations. l)e Mertens says, (p* 
45) that until the disease was mitigated by frost, at Mes< 
in 1771, scarcely four patients in a hundred recovered : but 
this must have been a most uncommon degree of mortality. 
. Desgenettes says that the French Egyptian army lost 700 
men of this disease, during their expedition into Syria, in 
the year seven ; and that in the year tight, about one-third 
were cured ; and he expresses gnat satisfaction in recollect- 
ing, that of 700 men under this disease, in the citadel ml' 
Kairo, in the year nine, more than one-third had escaped.* 

The deaths from this disease generally occur between the 
52nd and 5th days: those who survive the 7th day, are sup- 
posed to be in the way of recovery. Orrarus describes ait 
acute inflammatory form of plague which produced apoplexy 
or suffocation, and terminated fatally in i 24 hours. In this 
bleeding might probably have been useful. N Savarcsi, one of 
the French physicians in Egypt, says the disease sometimes 
occurred there with a fever, which he calls a synochus, and 
killed the patient in 24 or 36 hours, before any buboe, car- 
buncle, or eruption had manifested itself. Some cases oc- 

* Desgenettes Hist. Medicate, Sec. p. -250, says L'an h, cm nous avons eu dans Ik 
citadtlle du Kaire jusqu' a 700 pesliferes, uou avons en k douce mtiffaction d\ 
guerir au dessusdu tiers, & dans quelque cii constant i raoitie : les jewte* 

SKGRF.S & les Syrians au service de la republique ont panic it-lie rement souf 
la peste. 

Small as this success may be thought, it is great, compared * ith the results 
treatment, when sweating ««B practiced in the fullest extent. H .uria& 

de Pestil, p. ll, says, « Qui versati sunt in curandis qgrn hoc tempore, (, lagoe of 
1576,4 facile cngnoverunt, ex dentvm agris etiam decern ct ftnnrs fuiaM strratos." 



399 

Ciiired in the British and Indian armies, in which the powers 
of life seemed to be suddenly overcome by the disease, and in 
which death took place within a few hours, without any ap- 
parent effort or reaction of the system. I believe, how ever, 
that when persons are said to have suddenly dropped down 
dead from an attack of the plague, that the disease had com- 
monly subsisted some hours at least, though not avowed, or 
perhaps know n ; and in those cases w here persons supposed 
to be convalescent suddenly expire, it is probably from some 
over exertion, too great for the exhausted state of their excita- 
bility by the previous disease. 

Two cases of re-infection, or second attacks of plague, fell 
under my observation in Egypt ; — one occurred in Mr. Web- 
ster, then an Assistant Surgeon, and the other in a soldier of 
the 27th regiment, each of whom had a buboe; they were, how r - 
ever, but slightly indisposed, the weather having become hot. 
Dr. Buchan had a second attack, but with only a small car- 
buncle, as he informed me ; Dr. Price also had a second at- 
tack without cither buboe or carbuncle, but, according to his 
account, with a violent affection of the head and nervous sys- 
tem. In general, I think, second attacks are milder than the 
first, though Dr. Price informed me of his having seen a lad, 
who under such an attack, died on the second day. Pugnet 
says, p. 140, that reinfections, when they occurred, were 
oftenest in persons who had been mildly treated by the first 
attack ; and that several of these had the disease very violent- 
ly the second time, immediately after using the beds or blan- 
kets of persons who had died of it. 

Having, as I believe, already at pages 61 and 387-8 suf- 
ficiently shewn the impropriety of attempting to assimilate 
the plague with yellow fever, it seems expedient that I should 
do the like in regard to the endeavours which have been made 
to confound the former disease, at least as it has appeared in 
this country, with typhus fever. 

Sir John Pringle, at p. 319 of his work on the Diseases of 
the Army, says, " I shall not enter upon the distinction to 



400 

be made between a pestilential fever and the true plague :* the 
ancients are not clear upon this head, and those of the mo- 
derns who contend for a real difference, have not been able 
so to ascertain it, as to end the dispute.t I shall, therefore, 
only remark, that though the jail and hospital fever may dif- 
fer in specie from the plague, yet it must be accounted of the. 
same genus, as it proceeds from a similar cause, and is attend- 
ed with the like symptoms." 1 ! ! Where this distingu 
writer could imagine 4 that he had observed any likeness in the 
symptoms of these diseases, or any ground for considering 
them as the effect of a similar cause, I am unable to com i 
The late Dr. George Fordycc, however, believing that 
John I'ringle had not done enough, in considering the plague 
and typhus fever as diseases of one genus, lias strongly inti- 
jnated that the former disease never existed in this country, 
and that the latter was always mistaken for it. In his 
sertation on Simple Fe\er, this author makes the following 
observation respiting the plague, \iz : — 

"This infection has sometimes been brought into Km 
us was the case at Marseilles ; but that disease (ailed the 
plague, which ravaged this country, on considering the hi>tu- 

•Tlie connexion, rea! I, U-tween a particular state, or constitution of 

the atmosphere, and the Extraordinary preTalanf of plague, has induced persons, in 
different ages, to consider fevers which either preceded, or followed nek aa 
as partaking of the nature of the plague; and hence, fevers which had netti 
characteristic symptoms, nor the contagion of plague, have been denominate' 
lential /Inert. Sydenham, on the ground of this connexion, has not only described a 
pestilential fever of 1603 and loot*, but also a variolus fever, (of 1667,8, kc.) as he 
called it, because in his opinion, it " depended upon that epidemic constitution of the 
nir, which (as he says) of the same time produced thetmall pox „•" though this fever 
w as. not attended with any eruption, nor w ith any of the symptoms connected with an 
eruption ; and though it did not possess that peculiar contagion, which is essential to small 
pox. In regard to the production of any disease, specifically contagious by any u constitu- 
tion ot the air," it can only have been imagined ; and, therefore, those appellations 
of Jtestiteiituil, and variolous, were highly improper and fallacious. 

|A little common sense, according to my conceptions, would easily «* end the dis- 
pute." A disease it the plague, or it is not the plague.— If it be the plague, it should 

that name ;— and if not the plague, it should not be called p- 
those who would attach correct and precise meanings to words. 



401 

lies of the disease, seems to have been a fever produced by in- 
fections of the first class which have been enumerated. (" In- 
fectious matter produced in the body of a man afflicted with 
fever, or produced by a number of men living for a certain 
time in a small space." p. 121.) For the inhabitants of this 
country, (he adds) it is undoubtedly of great moment to de- 
cide this point, but it would make too great a digression. 
The author may perhaps lay the evidence before the public in 
an appendix." Unfortunately, however, the author is dead, 
and no publication of this evidence has been made, or is, as I 
understand, ever likely to be made ; I must, therefore, con- 
clude, that the judicious editor of the posthumous part of Dr. 
Fordyce's work, either did not find the evidence in question, 
or did not think it worthy of publication ; for otherwise, con- 
sidering the importance of the subject, we may presume that 
it' would not have been suppressed. But another physician, 
respectable by his own talents, character, and rank in our 
profession, as well as by those which his father possessed 
when alive, lias adopted, and endeavoured to support this 
opinion, that the destructive plague which formerly com- 
mitted such ravages at various times in London, and for the 
last time in 1665, was no other than our ordinary typhus or 
contagious fever ; an opinion for which I am unable to disco- 
ver the smallest foundation. Those who believe the physi- 
cians of the 17th century to have been so egregiously mistaken, 
must necessarily suppose they were unacquainted with the 
true plague, or that this disease has so much similitude with 
typhus fever, as to make it difficult to distinguish one from 
the other : that the first of these suppositions is at variance 
with the truth, must be evident to all who will refer to the 
descriptions of the plague, given by medical writers in those 
times, and more especially to the instructions prepared by 
the College of Physicians, and given to the Searchers at the 
beginning of the plague of 1665, in London, which point out 
51 



402 

most clearly and distinctly those symptoms and appearances 
which characterize the true Egyptian, or Levant plague ;* and 
which, without the grossest inattention, would have rendered 
it impossible even for the most ignorant, to have been mis- 
taken in regard to the disease generally, though they might 
have been liable to err in a particular case, where, from the 
causes heretofore mentioned, the appearance of glandular swel- 
lings, exanthemata, &c. was either obstructed or retarded. 
And in regard to the supposition of a similitude in the two 
diseases, I am not a little surprised that it should have been 
entertained by any one who had ever read even a tolerable 
description of the two diseases ; and I should be astonished 
if it were countenanced by one who had actually seen them. 

That the plague, as it formerly prevailed in London, was 
not a typhus fever, must be evident from the notorious fact 
of its having always been most extensive and fatal in the 
summer months, particularly August and September, when 



* The searchers appointed by authority in 1G65, were required, by the College of 
Physicians, " to take notice, whether there be any swellings, risings, or blotch, under 
the car, about the neck, on either side, or under the arm-pits of either side, or the 
groins; and of its hardness, and whether broken, or unbroken 

2ndly, " Whether there be any blains, which may rise in any part of the body, in 
the form of a blister, much bigger than the small pox, of a straw colour, or livid 
colour, which latter is the worser ; either of them hath a reddish circuit, something 
swollen, about it which drcuit remains after the blister is broken, encompassing the 



sore 



Sdly, " Whether there be any carbuncle, which is something like the Wain, but 
more fiery and corrosive, easily eating deep into the flesh, and sometimes having a 
black crust upon it, but ahpays compassed about with a very fiery red or Slid flat, and 
hard tumor, about a finger's breadth more or less; this, and the Main, may appear in 
any part of the body ? 

4thlv, " Whether there be any tokens, which are spots* arising upon the skin, chief- 
ly about the breast and back, but sometimes, also, in other parts ; their colour is some- 
thing various, sometimes more reddish, sometimes inclining a little towards a faint 
blue, and sometimes brownish, mixt with blue ; the red ones have often a purple circle 
about them ; the brownish, — a reddish ? 

5thly, " Whether the neck and the limbs are rigid or stiff, or more flexible and lim- 
ber, than in other dead bodies :" 



403 

there is a cessation of typhus fever : and the fact of its having 
been rendered nearly, if not completely, extinct, by the cold of 
winter, when typhus is commonly most active and prevalent ; 
for though intertropical heats exterminate or exclude the 
plague, and the summer heat of Egypt suspends its progress, 
the warmest weather in our country, is not too warm for the 
greatest ravages of the plague. 

That other diseases prevailed in London during the summer 
and autumn of 1665, and were confounded with the plague, I 
am disposed to conclude, because it was then commonly be- 
lieved that this disease, when raging so extensively and de- 
structively, had the power of converting all other diseases to 
its own nature ; and with this notion, fevers which had none 
of the distinguishing marks of the plague obtained that deno- 
mination ; but there are numerous facts and reasons which 
warrant a belief that these were marsh, and not typhus 
fevers. It will not be expedient that I should here adduce 
proofs (now well known) of the frequent and extensive preva- 
lence of intermitting and remitting fevers, in aiid about Lon- 
don, before the sources of miasmata were removed, or rendered 
unproductive, as they have been, in a great degree, for near 
a century. Morton affirms, that remittents were very destruc- 
tive from 1658 to'1664; and that sufficient causes for their 
recurrence existed in 1665, may be presumed from the long 
continued dry and hot weather which took place in the sum- 
mer of that year, though neither Sydenham nor Hodges have 
distinctly mentioned it.* The fever accompanying the plague 

* At page 13 of Loimologia, &c. Hodges observes, " the whole summer was re- 
freshed with moderate breezes, sufficient to prevent the air's stagnation and corrup- 
tion/' &c. and «* the heat was likewise too mild to encourage such corruption and 
fermentation as helps to taint the animal fluids," &c. It is probable, however, 
that, by these loose expressions, the author only meant, that the air did not 
stagnate, and that the heat was not so excessive as to produce the corrup- 
tion, &c. which are here mentioned; for, at page 20, be thinks it proper 
to advertise his readers, " that this year was most hixuriant in most fruits, 



404 

of that year was very commonly a remittent. Hodges, whose 
authority on this point is better than any other within my 
knowledge, mentions, at p. 49 of his Loimologia, that in this 
pestilence " persons frequently died without any preceding 
symptoms of horror, thirst, or concomitant fever ;" and of 
this he gives two instances, in which the disease undoubtedly 
was the true plague, adding, that although sometimes " no 
appearance could be discerned, even of a lurking fever, yet, 
for the most part some fever did shew itself." (p. 50.) And, 
at p. 51, he observes, that " the fever accompanying this 
present pestilence was of the worst kind, both on account of 

aud especially cherries and grapes, which were at so low a price that the 
common people surfeited with them ;" which, in regard to grapes at least 
would not have happened in this country without a summer of more than common 
heat It is, indeed, mentioned as such, distinctly, b> Mr. R. Hooke, in a letter 
to the Honourable Hobeit Boyle, dated July 8th, 1665, in which, after notifying the 
adjournment of the Royal Society by reason of the plague, he says, "I cannot, 
from any information I can learn of it, judge what its cause should be, but it seems to 
proceed only from infection or contagion, and that not catched, but by some near 
approach to some infected person or stuff; nor can I at all imagine it to be in the 
air, though there is one thing which is very different from what is usual m other hot 
summers, and that is a very great scarcity of flies and insects." See Boyle's works, 
(1772) vol. vi. page 901. And in regard to the stagnation of the atmosphere, and 
want of rain, Dr. Ldward Bay nan), (Physician n Bath) in page 252 of Sir John Floy- 
er's " Ancient -^vxgoXiirict revived," (printed in 1702)\Hriters, " I was at Chiswick, 
and sometimes in London, in the time of the great plague in the year 1665, and I 
very well remember,'' " during the time of the plague, there was such a general 
calm and serenity of weather, as if wind and rain also had been banished the realm, 
for many weeks togeQier, 1 could not observe the least breath of wind, not enough 
to stir a weathercook or fane ; if any, it was southerly." That there was an unusual 
drought in that year is farther manifested, at page 256 of the History of this Plague, 
by the following observation : " It pleased God to send a very plentiful year of corn 
and fruit, but not of hay or grass ; by which means bread was cheap, by reason of 
the plenty of corn ; flesh was cheap, by reason of the scarcity of grass ; but butter 
and cheese were dear for the same reason ; and hay, in the market just beyond White 
Chapel Bars, was sold at 4/ per load." In several places of the same work, (suppos- 
ed to have been written by Defoe) particularly at pages 145 and 146, the weather, in 
that summer, is stated to be " very hot " And in the then state of London and its 
vicinity, this hot and dry weather might well be expected to occasion more than the 
ordinary proportion of intermitting and remitting, but not of typhus, fevers. 



405 

its state and periods ; sometimes imitating a quotidian, at 
others a tertian; sometimes seeming to retreat, and at others 
attacking again, with redoubled fury. There was never (he 
adds) a total cessation, but sometimes a remission for an hour 
or two, although every exacerbation was worse than the for- 
mer." All this is very similar to an epidemic marsh remit- 
tent, and as unlike typhus fever as possible. The same 
author, in a letter addressed to a person of quality, and sub- 
joined to his Vindicise Medicinse & Medicorum, printed in 
London, aim. 1666, after mentioning the irregularity of the 
fits, or paroxysms, of the fever, in those who were ill of the 
plague, adds, that u they seemed most to resemble a double 
tertian ;" and that * in many, when the virulency was ex- 
pelled and spent, these fits did keep and observe their types, 
and became either pure or bastard tertians." — Or, in other 
words, that after the contagion of the plague had ceased to 
operate in the body, the influence of marsh miasmata, pre- 
viously imbibed, continued to produce its usual effects. 

In regard to the treatment of the disease, I shall offer but 
a few observations. It appears to have been a very early and 
general opinion among the physicians of this and other neigh- 
bouring countries, that those who were attacked by the plague, 
small pox, and other contagious diseases, had imbibed a mor- 
bid poison, and that it was necessary, above all things, to assist 
nature in expelling that poison from the body, and this princi- 
pally by sweating, which Morton called, 6i regiam viam" or 
the king's highway. In " certain rules, directions, or adver- 
tisements, for this time of pestilential contagion," " first 
published for the behoofe of the city of London," in " the 
visitation of 1603," * by Francis Herring, Doctor in Phy- 
sick, and Fellow of the College of Physicians," and re-pub- 
lished, upon the recurrence of the plague in 1625, copious 
sweatings were directed to be excited by strong sudorifics, 
with warm beds and bed clothes, " so soon as any of them 



406 

("the poorer sort of people'') apprehend themselves to be 
taken with the plague," and these were to be repeated every 
eight hours; and they were to " continue this course for four 
or five (lays; 99 and whilst sweating, it was enjoined not to 
"let them resi^orMeep. 99 * The same opinions, or mode 

* To discover the motive for this strange injunction, we must recollect that pati- 
ents in the plague are often comatose, or morbidly disposed to sleep; and as those 
who were so affected had commonly died, it was eo n ee i Ted that the poison of the dis- 
ease was enabled to exert its pernicious influence, more powerfully in a sleeping than 
in a waking state ; and, therefore, that it was of the greatest importance to hinder 
sleep, especially while attempts were making to dislodge the enemy by seating, and 
also when nature wns supposed to h roured to prrtduc* 

buboes. In an old work entitled, u De la manieie de pre* 

d' en guerir, par llenoit Tea »ns, in 1551, the author, 

at p. 130, makes this observation : " U'est un accident de grande importance, 
petuel on inseperaMe de cette maladie, que le long et pt ofmul dormir, i 
pour cette c;n t bataUler, t'onle 

er." And 1 !..ins himself more on ti 

150, in these words: " Quand le buboii le dormir est fort 

douimageabh , d' autanl qu 1 il retire an dedans la malice du renin. Et neantmoins e'est 
malndes y sotit plus enclins, et qu' il i faire a les empe* 

que par un tel moven nature K 
dfibroe de poulser eeste matiere m s, alors pour luy ai 

requis au malade, I'Ule hit \ cela on tasehera par {utroles recrea- 

;iar jeux, par hn '' >'a bicn hm ■ lUesdutnal- 

ade mesmes, par voiar aigue, on swnera det bassins, I hoses anpres 

deluv, on cornera, on J < tl s buttons, on ouvrira et fermera les partes, 

on quelque e on usera de pinsemens rudes, de ligatures 

tppelle bailler le moyne, on plmfera 

usement ecu pt I ties, on hty tit era les cheveux, la barbe, et pnticipalemeni les 
poih da I ra bien fort le nez et les mtreiile*, ou luy mtrrira 

les j/enx par force, ou y jettera du vinaigre, on les graiignera asprement, on le 

a, on le scourra, on I'exposera a la lumiere, on le tounnentrra en toute 
mtmicre, on rovandera en la maison on procedera prudemmeot par to>. 
faconsde (aire selon le personnagc. D'autre part pource que par le trop veiller Irs 

• vitauxse dissipent, dont souvent s'eusuit grande debilitation, pouro 

. si les malades demeurent tiop longueraent sans pottvoir dormir, ou y pour- 

voyera, ke" Certainly notliing but the most extravagant apprehensions of danger, 

from sleeping in the plague, could have induced a physician of good character sen- 

ouslv to ad\»se such violent, extraordinary, and indecent means to produce watch - 

SB, knowing as he did how much it contributed lo exhaust the powers of life 



407 

treatment were adopted in the <( advice set downe by the 
College of Physicians, by his Majesties speciall command," 
which was printed in 1630, along " with certaine statutes" 
concerning the plague in that year. By this it was directed 
" that there be good fires kept in, and about the visited houses, 
and their neighbours;" and "to make fires rather in pannes, 
to remove about the chambers, than in chimneys, the better 
to correct tho ay re of the houses." After which directions 
are given for the repeated administration of the most powerful 
sudorifics, upon the ground of opinions delivered in the fol- 
lowing sentence, viz. — " For as much as the cause of the 
plague, standeth rather in poison, than in any putrefaction of 
humours, as other agues doe, the chief est way is to move sweat- 
ings, and to defend the heart by some cordial thing. 

On the 13th May, 1665, the College of Physicians were re- 
quired by " a Committee" of the Privy Council, appointed 
by the king, " for prevention of the spreading of the infec- 
tion of the plague," to inspect the " Rules given by the Phy- 
sicians of former times, and imprinted for the public benefit," 
and to make such alterations as they should " find the (then) 
present times and occasions to require and to cause such their 
directions to be as speedily prepared and printed as possible ;" 
and the College in their answer or address to the said Com- 
mittee, on the 25th of May, signified that they had done as 
was required of them. And among the directions then pub- 
lished by the College, after the mention of bleeding, purging, 
and vomiting, they say u these three great remedies rarely 
have place in the plague, but are generally dangerous, and most 
of all purging, by any strong medicines ; and are therefore 
not to be used, but upon some extraordinary urgent indicant, 
or just occasion, and with the greatest caution, which only 
an able physician can judge of." They afterwards deliver it 
as their opinion, that "the poison is best expelled by sweat- 
ing, provoked by posset ale," " and London treacle" to the 



408 

quantity oi' ?ij mixed ; the Patient to " be put to bed to sweat 
well covered in a blanket, without his shirt, for twenty-four 
hours, every fifth hour renru nrdial. but in half the q 

tity" first taken, " between whiles refrrshin£ him with poeset 
drink, oatmeal caudle, or thin broths, made jell\ wim. or I. 
horn jelly," and, if necessary, warm hr'nhs. wetted with 
gpT, and wrapped iii flannels, wen- to be put to \\\> bet, and 
I air was to be taken that lie " -lap mJ till 

HUsU is wrre at the BUM time H bl applied. " behind the 
. about the wrists, mar tin armpit*, on the insidee of 
thighs, and near the grain," to "draw J venom." 

Tin- buboi s. or nrolHf of tlie lymphatic glands, were to be 
u always drawn forth, and riprnnl, and irdbj with all speed/ 9 

I bave mentioned tin m illustrate tin -.a- will 

as the means, by wbkfa pereOOB, writ- as I l- 
to deatli in the plague, small p<»\. miliar} 1 1 « I ab«»\e 

all, in the sweating sickness.* and with *o little Mispi< | 

' t Bay at m , ndeavor to dispel the obscurity in which the cans* and 

nature < knen «ef m i vnt I shall only oharnre 

thtl uV < sweat, and tin- mischiefs thereby occasioned ia this dbeaae, 

sue ; and to throw some hfrht upon the rf- 

tacr disease, I Trnture to introduce a pa rag r a ph, which 

■ >m a curious manuscript, part of Sir Hans Slaaae's Li- 

nIi Museum It is intituled •* A«<*tay{«0i«, or an 

< nod i cms rkhle in the bat Plague in the < 
m, Apcthecary," ke. He was also the author of Lon 
dinolopa, aire Lon<' IS. also in the British Museum; and his epitaph, 

44 was an honest just ma I in profession, and 

in the < I <iiu tongues, dc%! ^udyofann 

|.ti r 31, at page Ins, when going to treat of the cure of the plague, Mr. Bog- 
hurst sa\s, ■ Baton 1 hapsj this, I must needs say something consernsug a donht 
which hangs in in} mind, which I d at a little once or twine before, 

viz. whether strong sweats often repeated be an authentical, canonical rule, 
Nvhich will sbttb tor all sorts of paofli or cures, I wish some body of more skill would 
resolve the doubt : that which makes me doubt and stick raamaing this, is that I haw* 
seen so many this year of strong, lean, raw-boned, net-roan, (sinewy ) people, of snanh 
spirit and little humour, that have been t cry kmdobfy sweated, ami »«nxr an* im tmnlf 



109 

{he mischief, from a violent excitement and expenditure of the 
living power, produced by stimulating cordials, heated rooms, 
excessive covering, deprivation of sleep, &c. that all who 
escaped death under such treatment, were supposed to have 
been saved by it. 

Opinions equally erroneous were entertained of the nature 
and treatment of buboes, and cxanthematous eruptions, which, 
being considered as critical eruptions, tliough often occurring 
at the commencement of the disease, it was thought necessary 
to bring them as speedily as possible to a stat" of suppuration* 
by the most stimulant applications, in order, as was imagined, 
to extract the morbid poison, and e\cn to employ scarification 
or excision for the carbuncles. Sydenham w as indeed so fully 
convinced, that buboes and carbuncles were intended by na- 
ture to produce salutary evacuations, that he considered an 
attempt to discharge the morbid poison by artificial sweating, 
as an endeavour to force it into other outlets, than those which 
nature had selected tor this purpose. It seems highly proba- 
ble, that the buboes which accompany the plague, are no more 
the effect of an effort of nature to evacuate morbid matter, 
than those which occur in the venereal disease, or, after the 
introduction of variolous contagion by inoculation ; and it has 
been proved, in a multitude of instances, that no harm has re- 
sulted from the spontaneous resolution or dispersion of pesti- 
lential buboes without suppuration. Such instances have been 
often seen, and attested, by the most accurate and respectable 
writers on this disease : and though it may be proper to pro- 

if them have lived, but dyed all within two or three days ; and the sooner, by how much 
mate freely they sweated, and -ivere worst after sweating ; being much more subject to 
lightness of head, staggering, faintness, bleeding at the nose, miinzies in the throat ; and 
so'-ie had the tokens come out presently, which made me desist from much sweating 
such persons, and then I had many patients lusty men, who lived and never sweat at all, 
and are living to testily the same; and I observed that they that sweated freely of then- 
own accord seldom lived" The spontaneous sweatings here mentioned were doubtless 
Uie effect of a morbitl fnedispesition to that discharge, connected With debility, which fre- 
quently occurs in tb ; s (lipase, though it many patient*, who have the plague, there is 
an unusual drrmese of skin, and indisposition to perspire. 

53 



410 

mote their suppuration by emollient, and moderately stimulant 
cataplasms, kc, w here a natural disposition to that issue is 
evident ; there can, I think, be no danger in favouring their 
dispersion, or resolution, by the usual means, when we ob- 
serve a spontaneous tendency to such a termination.* I know 
that the sudden retrocession of buboes, previous to suppura- 
tion, and whilst other symptoms indicating danger, subsist un- 
abated, is often followed by death. But this mortality is not 
in such cases produced by any change in the buboe itself, or 
by the retention of any matter which ought to be discharged, 
but by such an extreme diminution of the living power, or 
other injurious effects of the dis< i asi incompatible with 

the continuation of a suppurating process, and also 'with the 
patient's recovery; and therefore, this ret i is to be 

considered not as the cause of death, but as an indication, and 
consequence of that condition of the patient, from which death 
isarihj resulted; and on theother hand, when these glan- 
dular swellings rise, and suppurate favourably, they indicate 
such a state of the living power, and of the system, as is likely 
to overcome the disease, without the supposed benefit of au 
evacuation of morbid poison by that suppuration. The same 
reasoning an, plicable to carbuncles, though in their 

gangrenous state, and when not surrounded bj ntric 

inflamed rings, they require h t stimulant applications, and 
afterwards such as will promote a suppuration, and i 
lion of the carbonaceous ( n 



* M aeri MS mya, " Though many bu- 

boes after they cum. tohredkat all, but sink away again, 

aiul byd ,e patient jro-w aW7, and emititute «o, mt- 

ur design to repel* divert, 
•'i, but only to suppurate them ; and in not more loruanl, or 

catory, \i\<* underneath theiu, 
thai M the pernicious ichorous neuter may have vent ; ami tluse blistering plasters Ud 
better success always, than aip/w^, or burning, or potential cauteriet ~ 



f BoghOTSt mentions, at p. 1 16 of bis MS. tbat in the \ 
to make incisions round eacli cat -biincle, and apply vinegar and salt to the fresh 
44 bnt to what purpose, (says he) I know not unless they delighted to torment people ; for 



' 411 

In regard to the treatment of the disease, generally, I have 
little to offer ; and, until we know more of the ways and means 
by which nature endeavours to overcome it, I am afraid we 
can do hut little for her assistance, otherwise than by restrain- 
ing all violent and dangerous symptoms, all excessive and 
debilitating evacuations, and supporting, when necessary, the 
powers of life, by a moderate use of wine, aether, opium, vola- 
tile alkali, and Peruvian bark. The instances of persons who 
have strangely recovered from the plague, after having wan- 
dered alone about the country, particularly in Egypt, exposed 
to cold and wet,* seem to indicate, that even the most mode- 
rate sweating is, at best, useless : but on the other hand, the 
unsuccessful trials made by Dr. Price, of the cold bath, afford 
no encouragement to repeat such applications to the surface. 
Jn some few cases, where the disease occurs in the vigorous 
and robust, and is accompanied with highly inflammatory 
symptoms, bleeding might, I think, prove beneficially, if em- 
ployed within a few hours from the attack ; though in general, 
very bad effects appear to have resulted from this evacuation. 
Mild emetics are said, in some cases, to have proved benefi- 
cial, given at the very beginning of the disease. 

Mercurial preparations were tried in Egypt, and probably 
thought not to have been previously employed in any other 
country for the plague. Diemerbroeck, however, mentions, 
at p. 268, their having been long before employed by Am- 
brose Pare, who bestowed some commendations upon them, 
(lib. 21, cap. 29,) with what justice, I will not decide. But 
during the plague at Marseilles, 1720, Diedier states, that he 
employed mercurial frictions, and pushed them as far as pos- 
sible, "ausi loin qu'on les pent porter," witlwut producing 
any good effect. See Traite de la Peste, p. 522, 

it put them to as much pain as if they had been on the rack." He adds that a French? 
man, after cutting round the carbuncles, used to pluck out the eschar with pincers, be- 
fore it was " ripe" for a separation. 

• Desgenettes mentions two remarkable cases of this kind, at p. H9, 150, and they 
are not the only ones which have been well attested. 



412 



•' 



Omens also asserts, p. 154, that lie had employed mereu- 
rials in various forms and doses, both internally and exter- 
nally, and that they did no good, "Nee minimam utilitatem 
prsestarunt." Pugnet, likewise, as he states, employed the 
same medicine, both internally and externally, without the 
smallest benefit, even in the cases for which it seemed most 
suitable, excepting a few instances where buboes were degene- 
rating into cold indolent tumours, and appeared to be improv- 
ed by applying mercurial ointment along the course of the 
lymphatics leading to them. Ho adds, that it did not obviate 
infection, as several persons caught the plague, whilst under 
salivation for venereal complaints. Sotira also declares, that 
he employed salivation in three persona ill of the plague, and 
that two of them died. Dr. Price, who probably tried saliva- 
tion to h greater exientthan any other person in Egypt, seems 
to have formed a better opinion of its effects ; and for the same 
fallacious reasons which have induced many persons to con- 
sider it as beneficial in yellow fever, viz. the recovery of MM 
patients, in whom he was able to excite a salivation, and the 
deaths of all those in whom he attempted to excite it, without 
success. He admitted, however, in a conversation with me, 
that lie had always found it extremely difficult to afTect lit 
lhary glands of persons under the plague, and was never able 
to do it by mercurial inunctions alone: and when I observed 
to him that a considerable time \sould be necessary to produce 
salivation by the means which he had employed : i. e. unction, 
and calomel internally, and that it seemed probable, that tboM 
who lived long enough to be salivated in this way, must ha\e 
previously passed over the dangerous part of the disease, and 
have been therefore likely to recover, if no salivation had ta- 
ken place ; — he admitted that my observation was probably 
just, and that the deaths of those in whom a salivation was 
not produced, had always taken place before tlu time which was 
commonly required to affect the salivary gUwUs. I bay. 
therefore, no difficulty in belioing. that the supposed benefit 
from salivation in tite plague, depend* upon fallacy similar to 



413 

that respecting yellow fever, which I have stated between 
pages 74 and 80. 

In regard to the frictions with oil, which were strongly 
recommended by Mr. Baldwin, I am afraid that but little 
benefit is to be expected from them in this disease ; like mer- 
cury, they appeared to be an old and discarded remedy, re- 
produced as a new one. Benoit Textor, in the publication 
lately mentioned, so long ago as 1551, says at p. 33, in re- 
gard to sweating for the plague : 

" Celuy qui ha besoing de suer doit estre fort frotte* par 
tout le corps, principalement avec huile de camomille, ou avec 
camomile & huile ou avec Pherbe dite nepeta, &c." — " Que le 
personnage se face bien couvrir & chauffer des quarreaux ou des 
briques aux piedz, ou appliquer dessouz les aixelles & es aincs, 
vessies remplies d'aue chaude." Riverius also recommended 
frictions over the whole body, with oil warmed, night and morn- 
ing, in the plague. See Prax. Med. lib. xvii. cap. 1. These 
frictions were, however, tried extensively by the French physi- 
cians in Egypt, and with very little, if any, benefit ; though in 
a few cases they seemed to give temporary ease and relief, 
Pugnet, indeed, says they were not only useless but caused 
anxiety and disturbance to the sick, that of 15 patients to whom 
these frictions were applied under the French physician Carrie, 
one recovered with difficulty, and ail the rest died ; and that 
where they seemed to do good, the disease was always mild. 
See p. 261. With so much reason to doubt of their utility, 
there is a strong objection to their use ; arising from the very 
great danger of communicating the disease to the unfortunate 
person by whose Jiands they may be applied, and thus de- 
stroying many lives, without much probability of saving one. 

END OF THE FIFTH AND LAST PART. 



APPENDIX. 

No. I. 



The following is Dr. Physic's communication, which I promised 
at p. 24 to insert in this appendix : viz. — 

" Some Observations on the Black Vomit, communicated by Dr. 
P. S. Physic, of Philadelphia, to Dr. Millar." Extracted from the 
5th volume of the New -York Medical Repository, 1802, — page 129. 

" Having, in the years 1798 and 1799 had frequent opportunities 
of dissecting the bodies of persons who died of the yellow fever in the 
City Hospital, I had thoughts of publishing a circumstantial detail of 
the several appearances in each case. On perusing, however, the 
descriptions given by late authors, I find but litde to add to them, ex- 
cept some observations respecting the black vomit, which do not ap- 
pear to have been particularly noticed. 

" The common opinion was, and for any thing I know to the con- 
trary is, at the present time, that this black matter is poured out by 
the liver. The dark -coloured appearance of the bile in its accumulated 
state, approaching more to the colour of the black vomit, than any 
other secreted fluid, would very readily induce a person to conclude 
that they were the same, if he did not compare and examine them 
carefully ; and, likewise, attend to several other circumstances." 

By such an examination the following differences have been ob- 
served. — 

" First, — If the darkest-coloured bile be spread thinly of er a white 
surface, such as the skin, it loses the colour it had in its accumulated 
state, and appears of a yellowish-green colour; but, if the black vomit 
be treated in the same way, it retains its black, or dark-brown ap- 
pearance. 

" Secondly, — The bile in the gall bladder has its common bitter 
taste, but the black vomit is insipid, or nearly so. This fact has been 
ascertained by several persons; and among others, by the late Dr. 
S. Cooper. I have inquired of a number of patients just after they 
had vomited k, they almost all declared it to have no taste ; and the 
organs of taste were proved to be perfect in these people, by trying 
whether they could distinguish between different tastes. It occasion- 
ally happens, that violent efforts made in vomiting, will force some 
bile out of the gall bladder into the stomach, and then the black vomit 
will have a bitter taste like bile. Dr. Cooper twice found it intensely 



416 



bitter 6\Ving to this circumstance, which, however, is a rare occur 
rence. 

" Thirdly, — The black vomit differs very much from any mixture 
that can be made of the dark-coloured bile, with any of the fluids- 
found in the stomach, or intestines. If bile be mixed with the mucus 
of the stomach, or, if some of it be added to the black vomit, it 
mixes with these uniformly, and imparts a yellowish- green tinge to 
them. The nearest resemblance to black vomit that could be made, 
was, by mixing some of the mucus of the stomach, a little blood, and 
some bile, together; but the difference was siiil very obvious. 

"Fourthly, — The stomach has been found full of black vomit, 
when, in the same subject, the fluid in the gall bladder and biliary 
ducts, was very different from it in its colour and appearance. I have 
found the gall bladder filled with a fluid of a brick-dust colour; in 
some others it contained a fluid of a light green colour; and, in 
others, a transparent and colourless fluid, resembling the white of an 
egg, only that it was of a thinner consistence. In some instances, 
again, a purulent-coloured fluid was found in them. Some of the 
same kind of fluid which the gall-bladder contained in these last-men- 
tioned htttand < nerally found in the duodenum; the stomach 
in the same body containing black vomit. 

H fifthly, — The pylorus, in several instances, has been found closel) 
Contracted, and yet, the stomach contained black matter. 

" The above observations have appeared to me to overthrow the idea 
of the black vomit bemg secreted by the liver. The question, how« 
still remains; — from whence is it derived? I believe it to be a si 
tion from the inflamed vessels of the stomach and intestines ; — and for 
the following reasons :— 

" First, — It is found in these viscera, when it cannot be detected in 
any other organ, or cavity connected with them. 

" Secondly, — It is often found of so thick a consistence, that 
not mix with the fluids of the stomach : in such cases, it adhen 
its inside, forming a black coat of considerable thickness; and, when it 
is once scratched off, it cannot be made to adhere again in the same 
manner. 

" I have, in one instance, observed this black substance in two al- 
most circular patches, each about two inches in diameter, adhering to 
the stomach ; and all the other parts being free from it. In this » 
there was no black matter loose in the cavity of the stomach nor ii 
tines. On scraping it off, the spots which had been covered by it, 
were found inflamed, and these spots only. Now, it can hardh 
possible for this black substance to have got into such a particular 
situation, had it been secreted by the liver; and some of it, in that 
rase, would have been observed in the gall bladder, gall d 
duodenum. 

m It must not be conjectured, that the black vomit irritated the sto- 
mach, and produced the inflammation: on the contrary. — Dr. > 
frequently repeated an experiment, which proved it to be very bl 
lie dropped it into his eyes, and never experienced any more incon- 
venience from it than if water had been u- 

irritated in dissecting, which once occurred to myself, I t 



417 

has arisen from some acrid substance having been swallowed by tfte 
patient just before death, as elixir vitriol, volatile alkali, 8cc. 

" Fourthly, — I have seen the inside of the inflamed stomach as 
black as the black vomit, resembling it in colour exactly. In most 
of these cases, no black matter was found in the cavity of the sto- 
mach. The vessels only which were inflamed were distended with it. 
This colour differs very much from the dark purple of a part in a state 
of gangrene ; and I never observed any putridity attending it. This 
blackness has, in some stomachs, been universal, in some in spots 
only ; the other spots being in a state of high inflammation, giving the 
inside of the stomach a chequered appearance. These spots, in one 
instance, were seen resembling each other in shape and figure exactly; 
and were, in every respect alike, except in colour ; the one being red,, 
the other black. Here some of the inflamed vessels only had gone 
into the act of forming black matter, but did not excrete it. 

" The secretion of black vomit appears to be one of the most 
common modes in which violent inflammation of the stomach has a 
disposition to terminate. Death, however, in general, takes place 
before it entirely disappears. I have seen many cases, which shew 
that the inflammation is diminished by the secretion; — of which, it 
will be sufficient to mention the following. On opening a stomach, 
one-half of it was coated with adhering black matter, while the other 
half was free from it; on scraping it off clean, and comparing the 
part underneath with the other half of the stomach which had not 
secreted any black matter, the difference in the degree of inflamma- 
tion was very striking, being much the least in the part which had 
been covered with the black substance. 

" In some cases, where the vomiting of black matter had been con- 
siderable in quantity, or continued fo? several days, the inflammation 
was found very faint indeed; and in some, the inside of the stomach 
appeared as if covered over with a vast number of sniall glands, like 
mucuous folicles crowded together." 

The author had also promised at p. 40, to give " the substance of 
another Memoir concerning the Black Vomit, written by Dr. Isaac 
Gathrall, of Philadelphia; which, however, by reason- of the room it 
would necessarily occupy, the editor of the latter parts of this volume 
has been forced to omit ; preserving, however, the following extracts, 
from an inaugural Dissertation on Malignant Fever, by Dr. Stubbins 
Ffirth, (now, or late, of Philadelphia,) relating to the appearances on 
the dissections of a considerable number of persons who had died of 
the yellow fever : viz. — 

" The brain was generally found in a diseased state, the meninges 
being considerably inflamed, the dura mater bein-- sometimes aggluti- 
nated to the pia mater, in consequence of the increased action of the 
arteries thereof. The blood vessels were turgid with blood, appearing 
as though they had been injected ; the substance of the brain was- 
harder and firmer than usual ; the ventricles frequently contained 
water, sometimes to the amount of several ounces ; in some cases, the 
rupture of a small vessel had taken place, and an effusion of blood was 
found between the pia and dura mater. 



418 



u The stomach was always found diseased ; great inflammation 
being observable throughout, and erosions of the villous coat frequent, 
nay, in a number of cases, whole portions thereof, of the size of a 
dollar, were detached, and found floating in the black vomit. The 
blood vessels were, in general, very much distended ; and, in one > 
their smaller extremities filled with a fluid similar to the black vomit 
in appearance, taste, and smell. This inflammation was frequently 
continued to the small intestines ; the duodenum was the most affect- 
ed, but the jejunium and ilium also suffered a part ; nay, the large in- 
testines by no means escaped free, for I have often found them consi- 
derably inflamed. 

" The spleen and pancreas were generally found in a healthy state; 
the kidnies were also generally sound ; but the bladder was, in a num- 
ber of cases, inflamed; and in some so contracted, that the cavity 
would not hold four ounces. 

" Tiie liver was generally, 1 might say almost always found in a 
healthy and natural state." — " I do not find amongst my papers any 
'evidence of its having been diseased, except in three of the pat 
that I examined, and, in two of them it had been of a chronic nan 
M The gall bladder was always found in a healthy - 
usual quantity of bile, and of a natural colour. I have preserved 
rimens of black vomit, and of bile, taken from the same pat 
shewing the difference, which is obvious from first sight. From i 
ry circuit I fed myself authorised to, and I do positively, as- 

sert, that black vomit is not an cretion of the liver; is not 

changed bile ; and docs not come from the liver, whatever others i 
assert to the contrary." To prove this, he says, 1st. — "* It is 1 
found in the gall bladder, the hepatic, or the cystic ducts, or the duc- 
tus choledochus communis." 2ndly. — The bile is found natural in 
the gall bladder, when the stomach is distended with black vomit*" 
SreMy. — M I have (bund the stomach distended with black- %omit, v 
the pylorus valve completely obstructed all p: odc- 

iium to the stomach, or \i me, the liver 

perfectly free from disease, and the bile in the gall bladder natural in 
colour, taste, and cons 4thly. — U I ha fthe 

stomach distended with a fluid similar to black vomit, and not to be 

iiruished from it by any means n ■ portion of the vii' 

coat of the stomach separated from Its D to the others, and 

space filled with black vomit, poured forth by the termination of the 
small arteries." See Dr. Cox's M< seum, vol. 1st. p. 116 

— 118. 

In some s of mortality from the yell. omach, 

death, is said to have been found v >f inllanu 

lion. But I do not recollect that any of tl. 

licularly as they ought to have been, or with such explanations 
could enable us to ascertain either tin \ of the obscr 

the c i deviations, if real, from the condition in which, 

according to my best information, that viscus h. en in at V 

49 out of $0j of the bodies of persons dead of yellow fever, which 
have been examined. In support of this observation, I coulc 
numerous proofs; but thinking them unn< . 1 shall only sub- 

join a few lines from an official statement, published in the Moni 



419 

" du 1 7 nivose an x i" (7th of January, 1803,) concerning the death, 
&c. of the Captain General Leclerc, (brother-in-law of the then First 
Consul of France,) at St. Domingo, who is therein declared to have 
been attacked with fever " le 8 Brumaire an xi." — " Et le medecin a 
declare ce meme jour, que c'etoit la maladie de Siam, dans toute son 
intensite" Sec. — " Le 10, le -vomissement a ete plus frequent, & est 
devenu noir" During the vomitings, it is stated that the skin ap- 
peared black, with a yellow tinge; and that blood escaped by the eyes. 
He died in the night between the 10th and 11th, "Brumaire." This 
statement is signed " Peyre, Medecin en Chef." The medical offi- 
cers who examined the body after death, declared that they had found 
u Vestomach extremement jihlogosr, la tunique interne sfihacelee, et en- 
duite d'une humeur noiratre et visqueuse." (The stomach very much 
inflamed ; its inner coat sphacelated, and covered with a blackish vis- 
cid fluid.) 

We are informed by Dr. Caldwell that " the existence of intro- 
suscefitio intestinalis, was the only actual discovery made by the 
knife of the anatomist, during the epidemic (at Philadelphia) in 1805. 
This affection was confined to the small intestines, and was found to 
exist in several cases of the disease. I believe, (says Dr. Caldwell,) 
the discovery was first made in private practice, by Dr. Stuart, and 
afterwards by Dr. Parish, at the City Hospital." — " The course of the 
intro-susception was always from above, downwards die upper por- 
tion of the intestines being the receiver, and the lower portion the re- 
ceived." Dr. Caldwell's Essay on the Pestilential or Yellow Fever 
at Philadelphia, in 1805, p. 179. 

Probably these intro-susceptions were produced by violent strain- 
ings to vomit. How frequently they happen in cases where the dis- 
ease proves mortal, will deserve, as far as possible, to be #scertained t 



APPENDIX 



NO II. 



♦The author, at p. 98, after giving decisive proofs "that if putrefy- 
ing animal matters arc not completely harmless, they are, at least, 
innocent of the charge of producing contagious fever," has referred 
-those who might desire farther evidence on this point, to his second 
appendix, which was intended to contain " rather a redundancy, than 
a deficiency of such proofs." But as the present volume is already 
extended beyond the author's expectation, and as the facts allotted for 
this appendix appear almost superfluous after those formerly stated, 
the editor ventures to omit by much the greater part thereof. 

The following statement is extracted from a letter written to the 
author by Mr. Lawrence, Anatomical Demonstrator at St. Bartholo- 
mew's Hospital ; whose character, talents, and professional acquire- 
ments, have already, at an early part of his life, greatly and justly 
advanced him in the road to eminence. It was dated February 21, 
1809. 

" In a constant attendance at the dissecting room of St. Bartholomew's 
'hospital for 'more than ten years, I have never seen any illness produc- 
ed by the closest attention to anatomical pursuits, except such as might 
be expected to follow from a similar confinement and application to 
any other employment. When it is considered that most of the stu- 
dents come from the country, and that many spend much time in dis- 
section, being employed also in writing, reading, fcc. during the rest 
of the day; it will not be a matter of surprise that their health should 
occasionally suffer : but the indisposition has never appeared to derive 
any peculiar character from the exposure of the subject to putrid ef- 
fluvia. Of course, you will except from this observation, the effects 
which may arise from the absorption of noxious matter from wounds 
received in dissection. It has not appeared to me, that ill consequen- 
ces of that description, follow more frequently from the dissection of 
the most putrid, than from that of recent bodies. The following par- 
ticulars will afford the most complete proof, that the exhalations from 
decomposing animal substances are not necessarily injurious to the 
human body. John Gilmore, together with his wife, and two sons, 
lived for ten years in a room under the anatomical buildings of St. 
Bartholomew's. The whole family slept, as well as spent the day, in 
this apartment, which received a very small quantity of light, in con- 
sequence of its single window opening against a high wall. The room 
was at the end of a passage, in which several tubs containing bones in 
a state of maceration were generally placed, and witii which other di- 
visions of the cellars communicated, containing large excavations for 



421 

receiving the refuse of the anatomical rooms. The latter were not 
separated from the general passage by any door. 

" The animal matters thrown into the receptacles just mentioned, 
are, I believe, converted into adipocire, and the fetor is consequently 
not so offensive as if they went through the putrefactive process ; but 
the whole place was constantly filled with a close cadaverous smell, 
very disagreeable to any persons who went down from the fresh air. 
During the whole day, Gilmore was employed about the dissecting 
room, in removing the offals, in cleaning macerated bones ; in short, 
in an almost constant handling of the most putrid matters. He al- 
ways enjoyed good health, was fat, and possessed very great bodily 
strength. He left his situation in consequence of an apoplectic at- 
tack, and died lately, at the age of 69, after two other similar affec- 
tions. His wife survives, enjoying a good state of health. Neither 
of his sons appears to have. suffered from any unwholesomeness of 
their abode. They are both hearty and strong, although they have 
been employed some years in attending the dissecting room. But the 
whole family left the cellar soon after the father's first attack." 

During the time that our very numerous fleet of transports lay in 
the bay of Aboukir, many bodies of sailors who had either died, or 
had been drowned, were washed on the shore, where they remained 
unburied, exposed to the heat of the sun. In riding to Rosetta, it 
was necessary to keep along the shore; and I passed 18 or 20 corpses 
in this situation. They were in various states of putrefaction ; but 
the stench from them all was offensive in the highest degree, and often 
extended to more than 100 yards. My curiosity led me to approach 
close to most of them, that I might examine the changes they had 
undergone. Some were swelled up to an enormous size, and the skin 
seemed so distended, that it appeared ready to burst. These were 
often of a dark-brown colour ; some had not yet come to that state; 
others had passed it ; and the skin having burst in several places, the 
air had escaped, and they had become more or less desiccated, and of 
a black colour. Every person who had occasion to pass from the 
camp to Rosetta, was obliged to come within reach of the vapours 
emitted by these bodies. There were orderly dragoons constantly 
passing ; yet, neither myself nor any one else, so far as I could learn, 
was attacked with fever, in consequence of our exposure to these va- 
pours ; and my professional situation would probably have enabled me 
to learn if any such consequence had followed. 

Orraeus Descriptio Pestis, Sec. p. 47. After stating that towards 
the decline of the plague in Moscow, in February, 1772, the College 
of Health received information " hinc inde in domibus emortuis 8c in- 

fectis cadavera clanculum inhumata vel aliter occultata repe- 

riri ;" — and that they ordered all the houses to be searched, offered 20 
roubles to informers, " et quae (cadavera) in locis spatiosis non sat 
profunde inhumata fuerunt, eorum sepulchra terra multa contegere, 
caetera vero nuda reperta in ccemeteria trans jwrtare." He says, 
" Hac ratione circiter mille cadavera in habit ationibus, ipsis reperta 
fuerunt. Notabile omino fuit neminem ex -vesfiillonibus, vel aliis in 
negotio hoc periculoso versantibus infectum, nedum morbo aiiquo 



422 

cerrujitum fuisse, quamvis tanta ab omni infectione mcolumitas vix ac 
ne vix quidem sperari posse videbatur." 

The good health commonly enjoyed by tallow chandlers and soap 
makers, is now too well known to require any evidence from me in 
confirmation of it, notwithstanding the very offensive and putrid exha- 
lations to which they, and particularly the former, are exposed. 
Glue and catgut makers are exposed to vapours equally corrupt and 
disagreeable. When riding on the Uxbridge road, near the 4th mile- 
stone, on the 14th of August, IS 10, I was assailed by an offensive 
smell of putrid animal matters, which I soon discovered to have come 
from a set of works near the road, employed in the making of glue ; 
adjoining to which were several huts belonging to the labourers and 
their families, most of whom I saw, and they all, both adults and 
children, had th^ appearance, and, as I was informed, the enjoyment 
of good health. I have heard the same of catgut manufacturers. 

In the Edinburgh Medical and Surgical Journal of October I, 
1810, may be seen an account, given by Dr. Chisholm, of a manu- 
factory (of which I had some knowledge from the time of its first 
establishment,) at Conham, near Bristol, destined for the conversion 
of animal flesh into a substance resembling spermaceti, by cutting up 
dead horses, asses, dogs, Sec. and putting their muscular parts into 
boxes with holes for the admission of water, and afterwards placing 
them in pits filled with water, while the entrails and useless parts of 
many hundreds of carcasses, were left to putrify on the surface of the 
ground. And it appears from Dr. Chisholm's statement, as well as 
from other information which was given to me on the subject, that 
though the effluvia of these putrefying animal matters were highly 
offensive to the overseer of this manufactory, and to the workmen 
employed under him, as well as to others within their reach, no injury 
was done by them to the health of any person, during the two years 
in winch these operations were continued. 

In regard to the morbid effects supposed to result from the putre- 
faction of fish, they appear, so far at least as regards fever, to have 
had no existence, but what was derived from the indiscriminating cre- 
dulity of such writers as Forestus. That a large whale was formerly 
cast ashore, and suffered to putrefy on the sea coast, near Egmont, in 
North Holland, (a place nearly surrounded by marshy or low grounds,) 
I am willing to believe ; but that the fever which is said by Forestus 
(tome 1, lib. 6) to have followed that event, was produced by the 
tvhale, rather than by marsh miasms, I cannot believe; because 
whales have not been found capable of producing such effects in later 
times,* and because fevers from marsh effluvia constantly fall under 
our observation. 

* See the account given by Dr. Gordon of a whale which putrefyed very harmlessly at 
the island of Santa Cruz, published in the appendix to Dr. Chisholm's Letter to Dr. 
Havgartb, p. 251 — 253. The same appendix contains an account of the putrefaction of 
'•IjOOO barrels of salted beef, at the same island, which were finally ordered to be thrown 
into the sea : and were thus disposed of without baring occasioned sickness to any person 
in the house, store, or neighborhood where tli is putrefaction had taken place and sub- 



423 

About the year 1788, a whale was stranded on the coast of France, 
near Havre de Grace, and M. Baussard, in an account of it, published 
in Rozier's Journal de Physique, for March, 1789, says, " Pendant 
quej' etois occupe a dissequer ce gross animal, une Lueur Phosphor- 
ique exhaloit de l'interieur de son corps, et une odeur tres ftetide de la 
tete." " Les exhalaisons m'ont occasionne des inflammations aux 
narines, et a la gorge et certains parties huileuses de la tete m'ont 
mis les mains dans un etat pitoyable." 

No mention is, however, made by M. Baussard, of any febrile af- 
fection occasioned either to himself or any other person by the putre- 
faction of this fish ; and that no such affections do, in fact, result from 
that cause was farther proved by the information which I obtained on 
the 2d of October, 1807, at the Greenland Dock, where the late pro- 
prietor, Mr. Ritchie, (who had just sold his property to Sir Charles 
Price and his associates for 35,000/.) informed me that for a consider* 
able time all the Greenland ships had been used to boil their blubber at 
this place, for which purpose five coppers, with proper coolers, &c. 
had been erected. Mr. Ritchie had lived more than 50 years in the 
neighbourhood of this dock, was well acquainted with the boiling pro* 
cess, and assured me, repeatedly, that though the blubber is often in a 
very offensive state, emitting an highly putrid smell, neither himself 
nor his people, nor the crews of the Greenland ships, who perform the 
whole boiling, &c. nor the neighbours, have ever, to his knowledge* 
suffered in their healths from that operation; that his people, and him- 
self, have always been healthy, and that he believes no crews are more 
healthy than those of the Greenland ships. This account was 
confirmed by the master of a Greenland ship then in the dock, who 
said he had been employed in the whale fishery for the last 22 years, 
excepting one year, and had been used to boil down the blubber for 16 
or 18 years of that time. He said besides, that the Greenland ships* 
on their return home, often smell very offensively to strangers, though 
to themselves the stench is imperceptible; that the casks in which 
they carry out their water are those in which they have brought home 
the blubber ; and that the water generally is found extremely offensive 
for some hours after the bung is taken out; in which state, however, 
the men are accustomed to drink it ; and, that notwithstanding all this % 
he does not conceive that any men are more healthy than the crews of 
those ships. That the stench from the blubber is universally admit- 
ted to be greatest when it is boiling ; and that these effluvia, so far 
from being at all unhealthy, are, on the contrary, reckoned so whole- 
some that it is very common for sick persons to come to the copper, as 
soon as they rise from their bed, aad to hold their heads over the 
steam, as close as they can. 

Mr. Ritchie informed me, that what remained of the blubber, after 
the boiling was finished, was now very commonly bought for agricul- 
tural purposes; that it was usually taken away by the purchasers just 
after the boiling, and was allowed to lie by a certain time, till it was in 
a proper state to be used as manure ; when it was laid upon the ground 
and found to be verv useful. 



424 

The use offish as manure is no new invention :* herrings, pilchards, 
and mackarel, have been long employed for this purpose in those parts 
of Great Britain where they are caught in the greatest abundance, and 
so are the various species of mollusca. In some parts of Cambridge- 
shire, &c. a small fresh-water fish called stickle -back, (gastyrosteus 
aculeatus, Lin.) becomes so plentiful, that, leaving their native ditches, 
they form vast shoals in the rivers, and being caught in nets, or bas- 
kets, are strewed over the ground, in the proportion of twenty bushels 
per acre. No morbid effect, however, so far as I can discover, has 
ever been known to result from the putrefaction of fish, or other animal 
matters employed in this way, though fevers ought to have resulted 
from it, if producible by the natural decomposition of animal substan* 
x:es. 

Putrid human excrement seems equally incapable of producing fe- 
ver. A nightman, who had been extensively employed for thirty years 
in this metropolis, assured me, that though his labourers frequently 
fell into asphyxia, or died off, as he called it} they had always reco- 
vered on being brought into the open air; that no fever had ever en- 
sued from such accidents, nor, as he believed, from this kind of occu- 
pation; that sometimes, from intemperance, and getting cold, they 
had feverish indispositions, but not more so than other labourers; and 
that, when steady and sober, he thought them remarkably healthy; 
that their eyes were sometimes affected, so as to produce temporary 
blindness, from which, however, they commonly recovered in a few 
days ; and that this, with asphyxia, were the only disorders to which 
he considered them as particularly liable from the nature of their occu- 
pation. 

The receptacles of human ordure belonging to the great hotels in 
Paris, being commonly very capacious, and very seldom emptied, 
those mephitic exhalations which here produce asphyxia, and are there 
called "filomb" seem to be highly concentrated, in these receptacles, 
because they produce death to the nightmen not unfrequendy, but, in 
other respects, their effects resemble those which are produced in this 
metropolis, as may be seen by a report, entitled, " Observations sur 
les fosses d'aisances et moyens de prevenir les inconveniens de leur 
vuidange," par M. M. Laborie, Cadet de Vaux, et Parmentier, (who 
had been employed by the French government to ascertain facts on 
this subject) published in the Journal de Physique, kc. An. 1778, p. 
444.— See also Ramazzini de morb. artific. cap. xiii. 



* In the * e New English Canaan, containing: an abstract of New England," written by 
Thomas Morton, " upon ten years knowledge and experiment of the Country," and 
printed at Amsterdam Ann. 163'J, are these passages; viz. (P 86,) " The Coast aboun- 
ded! with such multitudes of codd, that the inhabitants of New England doe dunge their 
grounds with codd." P. 89 " There is a fish (by some called shadds, by some :dlizes) 
that at the spring of the year passe up the rivers to spawn in the ponds, and are taken m 
such multitudes in every river that hath a pond at the end, that the inhabitants dunge theii 
ground with them. You may see in one tovneship a hundred 'acres together set with 
these fish, every acre taking 1000 of them : and an acre thus dressed will produce and 
yeald so much come as 3 acres without fish." This practice lias been mentioned by sev- 
eral other writers. 



APPENDIX 

NO. III. 



The purpose of this appendix has been stated, at pages 108 and 109 
of this volume. It will contain a faithful abstract of Mr. Holwell's 
narrative of his own sufferings, and those of his unfortunate compa- 
nions in the black-hole, at Calcutta, and more especially of the facts 
connected with the supposed production of fever by the crowding and 
suffocation which occurred in that situation.* 

Fort William, at Calcutta, had been surrendered to the Suba of 
Bengal, in the afternoon' of the 20th of June ; and, between 7 and 8 
o'clock of the same evening, Mr. Holwell, who had then become 
chief in council, with the other civil and military officers ot the India 
company, their servants and soldiers, amounting in all to 146 persons, 
were forcibly driven into a prison, called the black -hole, which was a 
cube of about eighteen feet, " shut up by dead walls on the east and 
south, (the only quarters from which the wind could reach them) by a 
wall and door to the north, and open only to the west, by two windows 
strongly barred, from which they could scarcely receive any the least 
circulation of air." In this state, these unfortunate persons, previ- 
ously exhausted by fatiguing exertions to defend the fort, and with only 
standing room, (i. e. 26 \ inches by 12 inches, to each person, upon the 
average) in a very sultry night, soon fell into an excessive perspiration, 
which was followed by extreme thirst ; and this became the more in- 
supportable, as their bodies were more and more deprived of moisture. 
To gain more room, they stript off all their clothes ; and, to relieve 
fee fatigue of standing upright, they all sat down on their hams, or rose 
up at given signals : but they were so wedged up while sitting down, 
that it required considerable efforts to rise, and several who were too 
weak to make such efforts, were either trodden to death or suffocated. 
" Urinous effluvia" soon pervaded the interior of the prison, which at 
last became very powerful, and, to use Mr. Holwell's words, " aftected 
them as if they were forcibly held with their heads over a bowl full of 
strong volatile spirit of hartshorn, until suffocating." (p. 26.) In the 
mean time, also, the atmosphere was gradually more and more vitia- 
ted; so that (p. 15,) "before 9 o'clock every man's thirst grew intole- 
rable, and resp iration difficult. In this distressing situation, the pri- 
soners cried loudly for water; and when water was at length brought 

* See " A genuine Narrative of the deplorable Deaths of the English Gentlemen, 
and others, who were suffocated in the Black Hole, in Fort William, at Calcutta, in 
the kingdom of Bengal, in the night succeei ling the 20th June, 1750. In a Letter to a 
FFiend, by J. 7 V Holwell, Esq. London, printed for A. Millar, in the Strand,. 1758." 

54 



426 

by some of the guards, with such eagerness did they struggle to get it, 
that not only the greatest part of the water handed in hats through the 
bars of the prison was spilt before it reached any one's lips, but many 
were trampled down and suffocated, while others, particularly those 
who stood near the windows, were pressed to death. It was soon, how- 
ever, discovered, that draughts of water were of little service towards 
quenching a thirst produced and kept up by such causes; they now, 
therefore, became clamorous for air, and endeavoured to force the 
door of the prison ; but finding their attempts vain, and, preferring an 
immediate death to the lingering extinction which they apprehended as 
their doom, they grew outrageous, and abused (p. 25, ) the Suba and 
his officers, and their own guards, by the most opprobrious names, " to 
provoke the latter to fire in upon them; every man that could, rushing 
tumultuously towards the window, with eager hopes of meeting the 
first shot. Then a general prayer to heaven to hasten the approach of 
the flames to the right and left of us, and put a period to our misery." 
After such violent exertions, they whose strength and spirits were 
quite exhausted, laid themselves down, and expired quietly upon some 
of their companions ; others, who had yet some strength left, made a 
last effort for the windows, and several succeeded by leaping and 
scrambling over the backs and heads of those in the first ranks, and 
got hold of the bars, from which there was no removing them after- 
wards. In this manner, which is more easily conceived than describ- 
ed, was the remainder of the night passed ; and when, at the dawn of 
day, an order was brought for their release, only 23 persons remained 
alive out of 146, and these were so weak that it took more than 20 mi- 
nutes to remOve the dead piled up against the door, so as to procure a 
passage out for one at a time. Of all those who survived, Mr. Holwell 
probably suffered the most in the course of that night, and certainly he 
had the narrowest escape from death; being one of the first who en- 
tered the prison, he had placed himself at a window, and continued 
there more than three hours, until his "legs were almost broken with 
the weight against them," and he was " at last so pressed and wedged 
lip by those who were clinging to the bars over him, as to be deprived 
of all motion." Unable to endure this torment, he begged the people 
about him, " as the last instance of their regard," " to make way that 
lie might retire from the window to die in quiet," and with difficulty he 
passed through them to the platform on the opposite side of the room. 
Here his distresses rapidly augmented, and, "in less than ten minutes, 
he was seized with a pain in the chest, and palpitation of the heart, both 
in the most exquisite degree." " He retained his senses, however, 
and not willing to bear any longer so much pain, without attempting to 
obtain the relief which he knew fresh air alone would afford, he pushed 
towards a window, and by an effort of double the strength he had ever 
before possessed, he found means to seize one of the bars, and to 
fix himself in the second rank of those who were standing at it. — 
The relief now felt was counterbalanced by new evils; for as others, 
in like manner, climbed and strove to get air, he presently had to 
sustain the weight of a heavy man, whose knees were pressing on 
his back, with the body resting on his head; a Dutch Serjeant had 
also seated himself on his left shoulder, and a black soldier on his 



427 

right, all which nothing could have enabled him long to support, but 

the props and pressure equally supporting him all around." 

In this position did he remain from half after 1 1 till about 2 o'clock, 
when, being exhausted by the repeated exertions he had made to dis- 
lodge these incumbrances, and finding that he must either quit the 
window, or sink were he was, he resolved on the former, having tru- 
ly, for the sake of others, suffered infinitely more for life, than the 
best of it is worth. With great labour he forced his way from the 
window, (several, in the inner ranks, appearing to him dead, while 
standing, and only prevented, by the throng about them, from fall- 
ing) and having gained the platform a second time, he lay down on it, 
and in a short time lost all sensation. Here he remained until near 
six o'clock in the morning, when the Suba, having been informed of 
the suffocation of most of the prisoners, sent to inquire if Mr. Hol- 
well had survived : and being told that there was an appearance of 
life remaining, and that he might recover if the door were opened 
very soon, an order came instantly for the release of the prisoners. 
In the mean time, Mr. Holwell had been brought to the window, 
where he revived in a few minutes, and was shortly after restored to his 
senses. As we have no information respecting the circumstances and 
consequences of this transaction, excepting that which was published 
by Mr. Holwell, and as his account of those consequences of neces- 
sity relates principally to his own case, (for he was immediately sepa- 
rated from all but three of the survivors,) I have thought it proper to 
describe minutely his sufferings, that the reader might the better un- 
derstand and decide, how far Dr. White, (in the Philosophical Trans- 
actions, vol. lxviii.) and Dr. P. A. Wilson, (in his treatise on febrile 
diseases, vol. i. p. 407) were justly intitled to adduce this transaction 
as an instance and proof of the generation, of " a most malignant 
and infectious fever," (these are Dr. White's words) by "the crowd- 
ing together of a number of men in camps, hospitals, jails," 8cc. 
It is true that Mr. Holwell, at p. 31 of his narrative, mentions his be- 
lief that very few of his companions had retained their senses during 
the time in which he was senseless, or if they did, that they " lost 
them soon after they came into the open air, by the fever they car- 
ried out with them :" he also mentions, at p. 34, that when taken out 
of prison he found himself in " a high putrid fever," and so weak as 
"not to be able to stand;" and he informs us, at p. 38, that in the 
ensuing night, he was " covered from head to foot with large painful 
biles," which he considered as "the first symptom of his recovery; 
for, until these appeared, his fever did not leave him." During the 
next night, his three companions, also, " broke out in biles all over 
their bodies ; a happy circumstance, (he adds) which, as I after- 
wards learned, attended eVery one who came out of the black hole." 
From these expressions, it has been pretended that the atmosphere 
of the prison being contaminated by the respiration, and perspiration, 
of so many persons, and by "the intolerable stench arising fro m the 
dead bodies," (as is mentioned by Mr. Holwell, at p. 32 ) had gene- 
rated contagion, and that this had produced in all the survivors that 
formal disease which is properly denominated fever. But, on a close 
examination of Mr. Holwell's statement, this will not be found to 



428 

nave happened, even though suffocation, from a -want of the vital 
part of the atmosphere, breathed by these unfortunate persons, had 
been superadded to the other evils of their situation, and had irreco- 
verably destroyed nearly six in seven of their whole number; for> 
with vital air enough to obviate suffocation, crowding, with all its con- 
sequences, would not have caused any of their deaths. That they 
should have lost their senses by being suddenly brought into a pure, 
open atmosphere, can surprize no one ; such a transition might well 
produce even greater changes upon men in their situation, without 
the aid, or existence, of fever, properly so called. And it appears 
evidently, from Mr. Holwell's statement, that he, and probably the 
others, very speedily recovered their senses : for he being carried im- 
mediately before the Suba, (or viceroy) who had heard or suspected 
that his prisoners had buried or concealed money and valuable effects, 
in the Fort, and wished, by violent threats, to extort a confession 
thereof from Mr. Holwell, the latter manifested such presence of 
mind, and power of reasoning, as could not have been expected of 
one who had been so recently brought back to life, even if no tem- 
porary suspension of intellect, or any other disorder than debility, had 
oc aired. We are informed, however, that the Suba, giving no cre- 
dit to Mr. Holwell's denials, ordered him to remain confined under 
the care of Mhir Muddon, general of his household troops, and he was 
consequently removed that morning, with his three companions, in a 
common carriage of the country, drawn by oxen, to the camp, " above 
three miles from the fort:" and soon after loaded with fetters ; and it 
was here that he passed the night, and was covered with biles, which 
put an end to his supposed fever, in less than 24 hours from its com- 
mencement. That Mr. Holwell, who had suffered so greatly, and in 
so many ways, during the preceding night, should have found him- 
self exhausted, disordered, and feverish, the following day, appears 
very natural: and perhaps it was not unnatural that using the word 
fever in a loose, and fiofiular sense, he should describe himself as 
having been in one. But that his disorder was not strictly a fever, 
and much less what has been understood by the term of putrid fever, 
will, I am confident, be readily admitted by every physician of ordi- 
nary candour and discernment. Indeed, Mr. Holwell may be pre- 
sumed to have had no other reason for giving the name of "putrid" 
to the febrile commotion which took place in him, than a supposition 
that any disorder occasioned by the heated and putrid atmosphere of 
the black hole, must necessarily partake of putridity. But if a putrid 
fever had really occurred, it is not credible that he could have been 
removed above three miles, exposed to the unclouded sun in that cli- 
mate, and yet relieved fromthis fever in less than twenty -four hours. 
It appears also (at p. 38) that Mr. Holwell and his companions were 
marched back to Calcutta the next morning " in their fetters, under 
the .scorching beams of an intensely hot sun," which certainly would 
require exertions too great for men, of whom one had been in a pu- 
trid fever but a few hours before, while the others were not then re- 
lieved from that with which they were said to have been attacked, and 
which only left them upon the occurrence of biles in the evening, after 
this fatiguing march. And certainly if Mr. Holwell's disorder, and 



429 

lhat, of his companions, had amounted to fever properly so called, 
such fatigue, if, against all credibility, they were capable of enduring 
it, must have been followed by consequences very different from any 
which appear to have been produced. Two days after this march, 
these gentlemen were embarked in a large open boat, and sent as 
prisoners up the river, to Muxadabad, then the capital of Bengal ; 
this voyage lasted 13 days, and, during the whole of it, they were ex- 
posed to one regular succession of heavy rain or intense sunshine," 
with no defence against either ; and their only food during most of 
the time, was rice and the muddy water of the river : they were be- 
sides " so distressed for room, that they could not stir without bruis- 
ing their own or each others biles;" moreover Mr. Holwell, on a par- 
ticular occasion, was forced out of the boat, and made to walk in the 
scorching sun about noon, more than a mile and a half from the ri- 
ver ; " his legs running in a stream of blood, from the irritation of his 
irons, and himself ready to drop at every step from excessive faint- 
ness, and unspeakable pain." " By this cruel travel" he became so 
exhausted, that his guards were forced to" carry him part of the w T ay 
back, and support him the rest of it. All these sufferings, however, 
did not produce fever. Mr. Holwell, indeed, tells us, (p. 47) lhat 
five or six days after this, " he was attacked by a fever on the night of 
his arrival" at Muxadabad, attended with considerable inflammation 
of his leg and thigh ; yet he adds that " all terminated the next night 
by a regular Jit of the gout in his right foot and ankle ;" a sufficient 
indication of the laxity and incorrectness with which Mr. Holwell has 
Used the term fever. 

Such are the facts relating to this singular transaction, and to me 
they prove decidedly, not that febrile contagion may be generated, by 
crowding many persons into a small space, without sufficient ventila- 
tion, but the reverse. For certainly the few who were recovered from 
the combined efforts of crowding and suffocation, escaped with less of 
indisposition than could have been reasonably expected, considering 
the cruel treatment which some, and probably all of them, afterwards 
sustained: and it cannot be fairly pretended, that this indisposition 
amounted, in a single individual, to that disease which is strictly de- 
nominated fever; much less to contagious fever, of which, indeed, 
there was not the slightest vestige or appearance. In none of the in- 
stances where crowding has been supposed to have generated febrile 
contagion, was it ever carried to the extent of suffocating, I will 
not say the greater, but even a small part of those subjected to it: 
and as in this case, (where, out of 146 persons, 123 were thus de- 
prived of life) neither contagion, nor even a fever, without contagion, 
was produced among the survivors, notwithstanding the concentrated 
exhalations from so many dead bodies, running speedily into putre- 
faction, (as their various excretions had done before) we may consi- 
der this as a most decisive proof that febrile contagion is not capable 
of being generated by causes of this description* 



APPENDIX, 

No. IV. 



The subject of this Appendix, viz. — The Black Assize at Oxford, 
anno 1577, and that of the Old Bailey, anno 1750, are mentioned at 
pages 110 and 111. 

Though I have taken considerable pains to throw light upon these 
remarkable events, the former, I fear, must always remain in great 
obscurity. The best account of it which I have been able to find, is 
that given in " The History and Antiquities of the University of Ox- 
ford," by Anthony A. Wood, M. A. of Merton College, first pub- 
lished in English, from the original MS. in the Bodleian Library, by 
John Gutch, A.M. printed at Oxford, &c. 1796. At p, 188 of the 
2nd volume of this work, we are informed by the author, that at this 
time, i. e. the 19th-20th of Queen Elizabeth, — " lived in Oxford a cer- 
tain book-binder, named Rowland Jencks, who, in his familiar dis- 
course, would not only rail against the commonwealth, but the religion 
now established, and sincerely by the generality in the university em- 
braced :" that " he made it his chief employment to vilify the govern- 
ment now settled; profane God's word; speak evilly of the ministers, 
Sec." — " In this course of life, he continuing for some time, taking 
glory, as it were, in it, the university to whom the said person belonged, 
(because privileged) took cognizance of him and his actions;" and 
i( a convocation of doctors, regents, and non-regents being held, May 
1 st, it was ordered that he should be seized on, and sent to London 
to be examined by the Chancellor of the University, and the Queen's 
Council." — Which was done. " But after he had been examined at 
London, he was sent to Oxford again to be committed to prison, and 
stand to a trial the next assizes following," &c ? 

" The assizes, therefore, being come, which began the 4th of 
July, and continued two days after, in the Court-House at the Cas- 
tle yard ; the said Jencks was arraigned, and condemned, in the 
presence of a great number of people, to lose his ears. Judg- 
ment being passed, and the prisoner taken away, there arose such 
an infectious damp., or breath among the people, that many there 
present, to the apprehensions of most men, were there smothered ; 
and others so deeply infected, that they lived not many hours after." 
Here Mr. Wood introduces an old ditty written upon that event, 
and printed in black letter, in which death is made to boast of his 
feats on that occasion. " The persons (continues Mr. Wood,) that 
then died, and were infected by the said dump, when sentence was 
passed, were Sir Robert Bell, Chief Baron of the Exchequer; Sir 



431 

Nicholas Barham, Sergeant at Law; both stiff enemies to the Ifcv 
man Catholic religion ; — Sir Robert Doiley, High-Sheriff; Hart, 
his Under-Sheriff; Sir William Babington, Knight ; with five Jus- 
tices of the Peace ;" and a considerable number of gentlemen who 
are named, " besides most of the jury, with many others that died 
in a day or two after. Above 600 sickened in one night, as a 
physician* that now lived at Oxford attesteth ; and the day "after, the 
infectious air being carried into the next village, f sickened there an 
hundred more. 

"The 15th, 16th, and 17th days of July sickened also j above 300 
persons, and within 12 days space died an hundred scholars, besides 
many citizens. The number of persons that died in five weeks space, 
namely, from the 6th of July to the 12th of August (for no longer did 
this violent infection continue,) were 300 in Oxford, and 200 and odd 
in other places, so that the whole number that died at that time 
were 510 persons, of whom many bled till they exfiired. The time, 
without doubt, was very calamitous and full of sorrow ; some leaving 
their beds, occasioned by the rage of their disease and pain, would beat 
their keepers or nurses, and drive them from their presence ; others, 
like madmen, would run about the streets, markets, lanes, and other 
places; some again would leap headlong into deep waters.'' — . 
" The physicians fled, — not to avoid trouble which came more and 
more upon them, but to save themselves and theirs.|| The doctors 
and heads of houses, all, almost to a man, fled, and not any college or 
hall was there, but had some taken away by this infection." Those 
who thus died, he says, " were troubled with a most vehement pain 
of the head and stomach, vexed with the fikrenzy, deprived of their 
understanding, memory, sight, hearing, Sec." — " At the time of their 
deaths, they would be very strong and vigorous, but if they escaped 
it they were to the contrary. "§ — " That which is most admired is, that 

• Dr. George Ethryg is the physician here alluded to. He practiced at that time in 
Oxford, and in the second book of his " Hypomnemata qusedam in aliquot Libra** Pairii 
JEgmatse," &c. printed in London, anno 1580, he states, that on the night in which the 
disease first made its appearance, about GOO were attacked by it, and in the next night 
100 more in the neighbouring villages. I 

f The carrying of the air to the neighbouring villages, seems to be a mistake. Those 
who sickened in them, had all been exposed to the cause of the disease, whatever it 
was, in the Court House, or in the Castle, as is stated in the register of Merton College, 
of which an extract was published in the Philosophical Transactions, vol. 50, p. 699 — 
70-', and in which, at p. 701, are these words:— " Nam illi solum ethic et aiibidzcum- 
4>ent segroti qui en castro et g-itilda, quam apellant aula quinto et sexto hujus mensia 
adsunt " 

+ This is also stated in the register o£ Merton College. 

|| This seems to have been an unnecessary, as well as culpable desertion of duty by 
the physicians ; the disease having never manifested any contagious property, whate- 
ver apprehensions might have been entertained on that subject at first. Besides the 
fact asserted in the Register of Merton College, that those only sickened who were 
present, &c. on the 5lh and 6th of July, and that no medical attendants, nor visitors 
were attacked, Mr. John Stow, in his Chronicle of England, (London. 1631) after 
saying that " there died in Oxford 300 persons, and in other places 200 and odd, 
from the 6th of July to the 12th of August," adds, "after which died not any of that 
sickness, for one of t/ietn infected not another." 

§ This account of the disease is in exact conformity with the Register of Merton 
College. 



432 

HO women were taken away by it, or poor people, or such that adm 
inlered fihyric, or any that came to -ciait* But as the physicians were- 
ignorant of the causes, so also of the cures of the disease." He adds, 
" many supposed that the cause of this infection proceeded from the 
nasty and pestilential smell of the prisoners when they came out of the 
jail, of whom, two or three being overcome with it, died a few days 
before the assize began, as a notef written in these times testifieth. 
If so be, that was the cause, (he adds) why then were none destroyed 
at the Jirfit appearance of the said prisoners, which was the 5th of 
July, when, as ? tis generally said,| none died till after sentence 
passed, which was the day following I Certainly, we cannot to the 
contrary but think, that the said smell or stench, was more violent the 
first time when the prisoners appeared, than when they had received 
air several times before." Here, however, he introduces the obst 
tion of Bacon, Lord Yerulam, mentioned at p. 109 of this volume. 
He afterwards informs us, that u some thought this Oxford mortality 
was the same that Leonard Fuschiua calls Sudor Anglitu; (sweating 
sickness,; which began first in England, anno 14S5. 1st Henry VII." 
Sec: but thi • Mr. AVood^thinks "not likely, because the natu 
that disease was almost quite different from the other." He a< 
u Some again have thought, and do think, that it was devised by the 
Roman catholics, who used the art :uigic in the design ; and that al- 
so, as a certain noteji witnesseth, it sprung M ex artincionis Diaboli- 
M r/v, et plane fiafiixticis flatibus e J.ovaniensi barathro excitatis, et ad 
* nos scelestibsime, et clam emissis." This notion, however, lu 
jects, as well as that of Sunderux, who ^de Schismate Angl. lib. iii.'i 
calls it " ingens miraeuluM)" and a just judgment on the I 
the judge, for sentencing tin- book-binder to lose his ears.§ 

The most important, and at tin same time the most obscure part of 
this account, is that which relates to the circumstances and means con- 
nected with the production of this disease. Slow, after mentioning the 
arraignment and condemnation of Jencks, M for his seditious tongue," 
' k At which time there arose amidst the people such a damp, that 
almost all were smothered ; very few escaped that were not taken at 
that instant ; — the jurors died presently," Sec. Annals of England- 
imprinted at London, by Ralfe Newberry, 1601. 

•This is also stated in the Renter of Merton College; ami Stow also asserts, 
(Loc. Citat) thai no woman or child died of the disease ; in which he is snpp 
by Sir Richard Baker, in hh chronicle of the Kings of England, p S53, and by Cam- 
den, in his A nnal Reginss, Elisabeth, 13 77, (Ed. Th. Hennas, 1717,) p. Slf 

| This is mentioned by the author from the entry in the Register of Merton Col 
to which be belonged; and thi \>ith ul.it h he wss well acquainted, appears 

to have been his only authority for stating, thai knot of the p ris oner * had died 

before the assize began, as I cannot find any thing of that sort mentioned by any other 
writer. 

litis is stated by Camden, and I believe, by Ilolliugshed, to whom I cannot now 
conveniently refer. 

; he author here alludes to the Register of Merton College, aral proceeds t.> I 
from it the words planed between inverted commits. 

§ Mr. Wood informs us, that after ''Rowland Jencks had suffered the set ■• 
passed upon him, he went to Donay, flfc Flanders) hihI there becaiv, 
English College of Seculars, ami lived: o be s very old m 



433 

Camden, (Loc. Citat.) after mentioning the bringing up of Jencks. 
tor judgment, adds, u venenos6 et pestilcnti halitu, sive f<zdore incar- 
teratorum, sive ex solo ita correpti sunt, plerique omnes qui ade«< 
rant ut," &c. And sir Richard Baker, at the page lately quoted, after 
mentioning the same proceedings against Jencks, adds, " Suddenly 
they were surprised with a pestilential savour, whether rising from the 
noisome smell of the prisoners, or from the damp ground,* is uncer- 
tain ; but all that were then present, almost every one, within forty 
hours died, except women and children." 

The most probable meaning of all these accounts would seem to be, 
that about the time when sentence was passed on the prisoners, a nox- 
ious vapour, in some degree perceptible by the senses, and proceed- 
ing either from the prisoners, or the earth, had been suddenly diffused 
through the hall, and that in consequence thereof, a great part of those 
who were present had been almost immediately attacked, and that 
many died within a few hours. 

There is, however, no cause of disease with which I am acquainted, 
whose effects would have been such as are here described. Pestilen- 
tial contagion cannot be suspected, because that would have required 
tontart, and because the symptoms of the disease were not like those 
of the plague, nor was it contagious. And there is as little reason to 
suspect the contagion of typhus or jail fever, (especially at that season 
of the year,) there being no instance recorded, or known, of its pro- 
ducing disease so suddenly, nor of that disease when produced, ter- 
minating so speedily in death. Nor were the symptoms such as oc- 
cur in jail fevers :f nor does the contagion of that fever spare women, 

* This expression, and that of Camden, seera to point at marsh effluvia, which, at 
that season of the year, would he more likely to occasion disease, than typhus con- 
tagion, and in a shorter space of time, and chiefly upon vigorous men ; probably, also, 
the situation of the place was suitable for their production. The old Shire Mail, in 
which sentence was passed on Rowland Jencks, was placed in the vard of Oxford Cas- 
tle, (once deemed impregnable,) which stood on the west skle of the town, at a small 
distance from the river /a*, whose hanks, especially at that time, were low The pri- 
son was also within the castle, at abo'it 300 yards distance from the hall, and consisted of 
a multangular tower, called St. George's, (on the west side of the castle,) together 
■with an adjoining church, which also bore the name ot St George, and two square 
rooms, all connected one with the other, and made the common gaol for the county, 
by a statute in the reign of Henry the 3d. See Grose's Antiquities of England, vol iv. 
p. 182-3 : also, King's Vestiges of Oxford Castle, p. '.':8. In the appendix to Thomas 
riearne's Preface to Gulielmi Neubrigensis llistoria, &c. p 88, is a print representing 
the eatsle of Oxford, and on the other side of the river is a mount, at the foot of which, 
are the ruins of an old building, which are thus described in a note to the plate : viz. — 
" Reliquiae domfis in qua astiZa olium tene bantur, donee ob pestem subitaneam, ad 
lilium civitatis locum regnante lAizabetha transferre placuit." But though I think marsh 
miasmata a more probable cause of the disease in question than typhus contagion, I am 
far from believing that they would have produced effects such as are said to have occup- 
ied it this black assize. 

fin addition to, and confirmation of the account of the symptoms of this disease, as 
stated by Mr. Wood, from the Register of Merton College, I will here subjoin that 
which was given to Mr. Bernard Gilpin, who after founding a grammar school at 
Houghton le Spring, in Durham, educated several young men there, and afterwards 
maintained them at the University of Oxford, which brought him into a correspondence 
with their college tutors, one of whom wrote a letter in Latin, giving an account of 
the disease in question of which an extract translated, has been preserved in "The Life 
of Bernard Gilpin, by William Gilpin, M, A." 2nd edition. Loudon, 1763, p. 120. 
.The translated account of this disease is in these words, viz. — "Those who are seized 
with it are in the utmost torment $ their bowels are burnt up ; they tall earnestly for 

■55 



434 

children, and poor people, as the cause of this disease is stated to have 
done, (but on the contrary:) — nor do the stoutest and most robust 
soonest perish by it, as the Register of Merton College declares to 
have happened in this disease. (" Et ut quifique fortissimus, ita citis- 
sime moritur.") 

Whether the facts connected with the production and nature of this 
disease have been misrepresented, or, whether it proceeded from a 
cause which has ceased to operate in later times, I leave for the deci- 
sion of others. 

The sickness which I have mentioned at p. 110, as occurring at 
Exeter, almost nine years after, viz. in 1586, appears to have been the 
true jail distemper, according to the account given of it by Hollings- 
head, vol. ii. p. 1547,. where he says, " At the assizes kept at the citie 
of Exeter, the 14th daie of March, in the eight and twentieth year of 
her majestie's reigne, before Sir Edmund Anderson, Knight, Lord 
Chief Justice of the Common Pleas, and Serjeant Floredaie, one of 
the Barons of the Exchequer, Justices of the Assize in the county of 
Devon and Exon, there happened a very sudden and strange sickness, 
first among the prisoners in the jail of the castle of Exon, and then 
dispersed (upon their triall) amongst sundrie other persons." — " This 
sickness was very sharp for the time, and few escaped which at the 
first were infected therewith. It was contagious and infectious, but 
not so violent as commonlie the pestilence is; neither doth there ap- 
peare anie outwarde bleer or sore." — " The origin and cause thereof, 
diverse men are of diverse judgments. Some did impute it, and were 
of the mind that it proceeded from the contagion of a gaole, which, 
by reason of the close aire and filthie stinke, the prisoners newly come 
out of a fresh aire into the same^ are, in a short time, for the most 
part, infected therewith ; and this is commonlie called gaole sickness, 
and many die thereof." He then proceeds to relate the case of thirty- 
eight Portuguese seamen, who had been some time before taken at 
sea, coming with fish from Newfoundland, and " cast into the deep pit 
and stinking dungeon" of the " gaole of the castle of Exon ;" and M had 
no change of apparell," but being left to lie " upon the ground, with- 
out succour or reliefe, were soon infected ;" (probably by the conta- 
gion previously existing in this dungeon,) " and all, for the most part, 
were sicke, and some of them died, and some of them was (were) dis- 
tracted ; and this sickness verie soon after dispersed itselfe among all 
the residue of the prisoners in the gaole, of which disease many of 
them died, 1)ut. all brought to great extremities, and verie hardlie es- 

drink ; they cannot l>ear the touch of clothes ; they intreat the slanders by to throw cold 
water Upon them; sometimes they are i[iiite mat! ; rise upon their keepers ; run nuked 
out of houses ; and often endeavour lo put an end to their lives The physicians are 
eonfoumfed, declaring they have met with nothing similar, either in their reading or prac- 
tice. Yet many of them give this distemper :t name, though they have done nothing to 
shew that they are at all acquainted with its nature. The greater part of them lam 
told, have now left the town, either, out of lear for themselves, or, conscious that they 
can do no good This dreadful distemper is now generally attributed to some jail 
infection, brought into court at the assizes : for it is remarkable, that the first infected 
were those only who had been there. Few women or old men have died. God be 
thanked, the rage of this pestilence is now much abated. It is still araor.£ us, in some 
degree, but its effects appear every day weaker/' 



43, 



taped. These men, when they were brought before the foresaid jus- 
tices for their trial], manie of them were so weake and sicke, that they 
were not able to go nor stand, but were carried from the gaole to the 
place of judgment, some upon hand-barrows, and some between men 
leading them, 8cc. He adds, that these miserable men were brought 
in at "one end of the hall, near to the judge's seat," where their 
wretched condition excited general commiseration, and particularly 
that of the chief justice, " who, upon this occasion, tooke <z better or- 
der for keeping all prisoners thenceforth in the gaole," Sec. He adds, 
"And howsoever the matter fell out. and by what occasion it hap- 
pened, an infection followed upon manie, and a great number of such 
as were mere in the- court, and especially such as were nearest to 
them, were soonest infected. And albeit the infection was not then 
perceived, because everie man departed, as he thought, in as goo4 
health as he came thither ; yet, the same by little* and little, so crept 
into such upon whom the infection was seizoned, that after a few daies, 
and at their homecoming to their own houses, they fek the violence of 
this pestilent sickness, wherein more died that were infected, than es- 
caped." He then gives the names of some of the principal persons 
who were thus cut off; among whom were Serjeant Floridaie, one of 
the judges ; three knights ; and several esquires and justices of the 
peace ; and many constables, reeves, tythingmen, Sec. In this case, 
the disease appears to have been propagated by those who were first 
attacked, so that "it was dispersed throughout all the whole shire." 
And, on this subject the author makes an important, and I believe just 
observation, concerning the time which the infection remained dormant 
in the system : viz. — " It resteth for the most part, fourtecne dales 
and upwards, by a secret infection, before it breake out into his force 
and violence." Ail this is -very unlike the disease from which the 
black assize at Oxford obtained that appellation. 

I am next, according to the promise made at p. Ill of this volume, 
to enter upon an examination of the facts relating to the supposed pro- 
pagation of typhus or jail fever, at the Spring sessions of 1750, in 
the Old Bailey, by contagion from Newgate. 

I have already mentioned that Sir John Pringle's Observations on 
" Hospital and Jayl Fevers," were published (probably written also,) 
immediately after, and to take advantage of the sickness which then' 
occurred. In his dedication of that publication to Dr. Mead, he says, 
"Whilst I was revising the notes I had made on the Diseases i 
incident to an Army, the jayl distemper having broke out in such a 
manner, as to alarm the town, I thought I could not comply more 
seasonably with yo^r desire of having them published, than by c 
municating at present, that part of my observations which related to 
this disease." He says afterwards, that he the more willingly em- 
braces this occasion of writing, (i as at this time every body is incl 
to listen to the subject," &c; adding, "lam certain, thac how< 
rarely our jayls produce such visible noxious effects, they are often 
one of the more insidious sources of slow and malignant fevers, which 
generally prevail in large and crowded cities. Thus, in the late ca&c 
of infection: — from the quantity of the contagious matter, the close- 
ness of the air, and crowds of people to render its corruption more 



quick, a distemper arose so suddenly, and was so vii 

and fatal, that every body now refers it to it* true cause ; where 

the number of malefactors had been fewer, the multitude less, and 

the air freer, so few would ha\ e been seized, and that with fevers 

slow and less alarmhnj kind, that the cause might have been kui 

overlooked." 

By thus confidently representing the Old Bailey sickn 
product of jail infection, Sir John Pringle obviously secured a 
general attention to his publication, and gave it unusual imp*. 
that time. But 1 think too highly of his probity, to marine mat h<- 
would, from such considerations, intentionally mislead tip and, 

therefore, 1 am the more surprised, that he should have thus assum- 
ed to know, and decide upon, u tin- true cause*' of thi . and 
upon "the quantity of contagious matter" supposed to prodm 
without having seen any one of tin- persons who had been attacked by 
the disease; and without having, in the smallest decree, ascertained 
the existence even of a single atom of contagious matter, at that time, 
in Newgate. 

But, though Sir John Pringle, in this his first publication, confined 
himself to general, and gratuitous assumptions, respecting this trans- 
action, he afterwards, in his work on the Diseases of tli first 
published in 175 J, gave a statement of what he considered as the prin- 
cipal facts relating to it ; and, as this statement seems to be the founda- 
tion of almost all that has been si^ce written, and believed by others on 
this subject, I shall here subjoin it, from the seventh edition of that 
work, which contains,! believe, his latest additions and alterations; 
introducing, in the form of notes, such corrections and explanations as 
seem necessary. The statement is at p. 330) and seq. in these words, 
viz. — u In the year 1750, on the 1 1th of May,* the sessions began at 
the Old Bailey, and continued for some days; in which time, there 
were more criminals tried, and a greater multitude present in the 
court, than usual. The hall in the Old Bailey, was a room of i 
about 30 feet square. t Now, whether the air was most tainted from 
the bar, by some of the prisoners, then ill of the jail distem/ier y or, by 

* The sessions began, as is proved by all the diurnal, and monthly publications of that 
time, on the 25 tk of tpril, oldstyle, and ended on the 30th. Sir John I 
lure to designate the time according to the ncm style, which was afterwards 
bylaw, as is evident, by his having annexed die letters N- S. to the 
his account given in the JBtt edition of his volume on the Diseases of the A 
evrii this left him in an error of five days. The Universal Magazim 
contains the following passage : — "Wednesday, the £5th, the sessions 
Bailey; when 23 prisoners were tried ;" kc and it added, that on '• 
26th, (eh persona were tried; and among them ''Captain Edward Clark, tor shooting 
Captain Thomas lnnes, in a duel, in Hyde Park,*' .March the 12th. I 
were captains in the royal navy, and Captain Clark's trial excitinc 
produced a very crowded court, and lasted a great part ol so that oolj 

Other prisoners were tried. And it was on this day, the Mth, as will be seen | 
that the cause of the disease, whatever it may have been, 

who afterwards sickened, and who appear to have been all ! on'y then. 

There was, indeed, so far as 1 can discover, no trial during the sessions of th 
•w Inch excited any gnat curiosity, or occasioned any crowd; nor will Sir John Pri- _ 
reasonings or description: apply to any other day. 

\ According to the measurement of Mr. Dance. Clerk of the Works to the 

of London, this hall was 4<> jfetin length, and ot ft-;! in breadth. 



437 

the general unclean liness of such persons, is uncertain ;* but it is pro- 
bable that both causes concurred. And, we may easily conceive, how 
much the air might have been vitiated by the foul steams of the Bail- 
dock, and of the two rooms opening into the court, in which the pri- 
soners were the whole day crowded together, till they were brought 
out to be tried. f It appeared, afterwards, that those places had not 
been cleaned for some years. The poisonous quality of the air was ag- 
gravated by the heat and closeness of the court, and by the perspirable 
matter of a number of people, of all sorts, penned up for the most 
part of the day, without breaming the free air, or receiving any refresh- 
ment4 The bench consisted of six persons, whereof four died, to- 
gether with two or three of the counsel, one of the under-sheriffs, 
several of the Middlesex Jury, and others present, to the amount of 
above forty ; without making allowance for those of a lower rank, whose 
death may not have been heard of; and without including any that did 
not sicken within a fortnight after the sessions. 

" It was said,\\ that this fever, in the beginning, had an inflamma- 
tory appearance, but that after. large evacuations the pulse sunk, and 
was not to be raised by blisters, nor cordials ; and the patients soon be- 
came delirious. Some had petechia?, and all that were seized with the 
fever died, excepting two or three at most. Some escaped without a 
fever, by a looseness coming on, and which was easily cured. How 

* This question, of all others, ought not to have been left, and much less represented, 
as being in a state of uncertainty ; since all our reasonings and conclusions wilt almost 
exclusively depend upon it. Sir John Pringle certainly had no good reason to suppose 
that any person in Newgate w» " then ill of the jail distemper, and much less any of 
tlie prisoners at the bar; and his language is therefore fallacious. In regard to "the 
general uncleanliness of such persons," I shall indeed wonder if any one, after reading 
this volume, can believe it to have been capable of producing the disease under con- 
sideration. 

f In a note to this passage, Sir John Pringle mentions his having heard, that about 
100 prisoners were tried at these sessions, and he supposes that ihey " were all kept*' 
in "tlie bail-dock, and the two rooms opening into the court," — "as long as the court 
sat,' ; — -which is, 1 believe, an error : for though care is taken, that a sufficient num- 
ber of prisoners shall always be in readiness for trial, the whole number is not, accor- 
ding to my information, brought up at once, when it is known that they cannot all be 
tried in one day. Sir John Pringle seems also to have formed erroneous ideas of the 
situation of the bail-dock, &c. It will be seen by the plan of the Sessions House, or 
Justice Hall, in the Old Bailey, between pages 438 and 459, that the bail-dock is pla- 
ced -without, and in front of the house, and is a kind of vaulted cell or dungeon, below 
the surface of the court yard, where the prisoners are kept, until called successively 
into court, a few minutes before their respective trials are expected to commence. 
And while in the bail-dock, they must be too far removed, and too much separated 
from the hall, to infect thecourt, even if they were all labouring under jail fever. la 
regard to the " two rooms opening into the court, " and which he supposes to have been 
crowded with prisoners, they must have been merely partitions within the bail-dock, 
to separate the men from the women. 

i The heat and closeness of the court, with the quantity of perspirable matter from 
those who were u penned up in' it, for a few hours, will bear no sort of comparison 
with the state of the Black Hole at Calcutta, vhere we have seen that nothing like 
contagion, or a regular, and much less a mortal fever was produced. 

|| This, and other expressions, demonstrate that Sir John Pringle did not attend a 
single person labouring under this fever ; — for, if he had done so. it would not have 
been necessary for him to recur to hearsay ; and he would certainly have given us a 
distinct account of the symptoms, especially as all those who did attend in this sickness, 
had strangely neglected this duty ; so that we have nothing but loose hearsays on a point 
«f great interest and importance. 



- 

far this sickness spread among the nurses, and other attendants on 
sick, is not known."* 

Sir John Pringle has mentioned in a note, that the persons on the 
bench of the judges were, " The lord mayor, three of the judges, one 
oi" the aldermen, and the recorder. Of these (he adds) died Sir 
muel Pennant, Lord Mayor; Sir Thomas Abney, and Baron Ch 
Judges; and Sir Daniel Lambert, Alderman. It was remarkable that 
the lord chief justice, and the recorder, who sat on the lord mayor's 
right hand, escaped, whilst he himself, with the rest of the bench on 
his left, were seized with the infection ; that the Middlesex Jury, on the 
left side of the court lost many, whilst the London Jury opposite to 
them received no harm ; and that of the whole multitude, but one or 
two, or at most, a small number of those who were on the Lord 
Mayor's right hand, were taken ill. Some, unacquainted with the dan- 
gerous nature of putrid effluvia, have ascribed both this circumstance, 
and the sickness in general, to a cold tak *c*j' <* windo-: 

by which a stream of air was directed to the side of the court on the 
Lord Mayor's left hand.f But it is • be observed, that the window 

• I am km 
ion I li • . had sad, ** This 

I 

ed its 
en a jail fever* In the , (primed in 1765,] 

author says, "I i no farther; there fceii 

that time Ao disposition in the air, nor other oironnaatanecs to propagate the bifoatkai * 
Here it is manifest, lhathev J no person hail taken the disease from any ot" 

those who oked, and that he vatMpnxious to ©' 

enoe suggested I at the d.sease was not the jail feler, by s 

what he < here was then u no disposition in tJieair, 

when, in feet, the unusual coli ropagate the infection. ' 

Whether Sir John Pringlc was convinced of the insufficiency of these allegations, to ex- 
plain why the disease /...■ communicatee I lie sick, 1 know not ; I.' 
afterwards thought prosier, in his 7th edition, printed in 1774, to suppress theses 
lions, and represent it as being uncertain, w nether the disease hail, or had not, been i 
immicatcd by s contagious quality, or ratlin 
M spread fee; affording room for' a belief that it had in fact I 
nurses," &c- though the extent of its spreading was unknown. Twenty four ; 
hail then elapsed, and with the dispositions which were manifested by Sir John 
l'ringle on this subject, it may be safely inferred, that he had never in all that 
been able to gain any information, rendering it probable that the fever under cons 
tion, had been propagated in a single instance by contagion. For a single well -ascertain- 
ed fact of this nature, would have answered his purpose, by proving that the disease waa 
ajail fever, and have tendered unnecessary all his other laborious and ineffectual endea- 
vors to attain this object 

■\ In the Gentleman's Magazine for May, 1750, (p. 235, J the folio* ing paragraph rela- 
ting to this subject may be found, viz : — " As there was no uru-ommo: nong 
the prisoners that came to the bar, or in Newgate, some at lent \\ e observe i-s do not sup- 
pose it to be a case of infection. Hut that the court being so much he.Ued by the crowds 
which came to hear the extraordinary trials of Captain Clark and others, 
a eery cold piercing East tf'ind to attack the sweating pei 
court > and many of them dining in public, and drinking perhaps 
to comfort them after fatigue, a fatal fever might ensue?" The writer of this parag 
though he properly ascribes the fever to a piercing cold V 
been sufficiently informed of a most importi mnected wki 
in which this a iod « as applied, so as to produce diseas the mpenmu 

»in front, and on I 
ing, one of 

lone it) consequence of tin 
of the hall, < 



439 

was at the furthest end of the room from the bench, though the judges 
suffered most. Nor could the kind of fever, nor the mortality attend- 
ing it, be attributed to a cold ; it is therefore probable, that the air 
from the window, directed the putrid streams to that part of the court 
above-mentioned. Indeed, it must be granted, that septic particles 
passing into the blood, become more active and fatal, if the infected 
person catches cold, or, by any accident suffers a stoppage of perspi- 
ration, or of any of the other discharges of excrementitious and noxious 
matter. 

Before I particularly notice the latter part of the preceding note, I 
think it proper to introduce some other testimonies on this subject. 

In Foster's Reports and Cases on Crown Law, (printed at Oxford, 
1762, folio,) I find, at p. 72, the following statements, viz : — 

"At the Old Bailey sessions in April, 1750, one Mr. Clark was 
brought to his trial ; and, it being a case of great expectation, the 
court, and all the passages to it were extremely crowded, Sec. 

" Many people who were in court at this time, were sensibly affected 
with a very noisome smell ; and, it appeared soon afterwards, upon an 
enquiry ordered by the Court of Aldermen,* that the whole prison of 
Newgate, and all the passages leading thence into the court, were in 
a very filthy condition, and had long been so. 

" What made these circumstances to be at all attended to, was, that 
within a week, or ten days at most, after the session, many people wh« 
were present at Mr. Clark's trial, were seized with a fever of the ma- 
lignant kind ; and few who were seized recovered. 

" The symptoms were much alike in all the patients ; and, in less 
than six weeks time, the distemper entirely ceased. 

" It ought to be remembered, that at the time this disaster happen- 
ed, there ivas no sickness in the gaol more than is common in such 
places; this circumstance, which distinguisheth this from most of 
the cases of the like kind which we have heard of, suggesteth a very 
proper* caution: — Ned to presume too far v/ion the health of the 
gaol, barely because the gaol fever is not among the prisoners. 1 * 

In addition to the preceding statement, it will be proper for me to 
introduce the testimony of the Rev. Stephen Hales, D. D and F. R. 
S. whose character as a divine, and philosopher, needs no encomium 
from me. He attended as a witness to Captain Clark's character 
upon the trial in question; and,, in the second part of his Treatise on 
Ventilators, (printed in 1750,) at p. 161, after quoting a consider- 
ed ; ant], upon the opening: of the window", a stream of cold air forcibly rushed in, and pas-> 
sed straight foi word along that side of the hall which was nearest to the street, and on the 
left hand of the Lord Mayor. And the mischief done, or sickness produced, appears to 
have been confined to those whe were placed in the direction of this stream of cold air ; 
which, therefore, contained and conveyed tlie morbid in faience, whatever it ivas, that occa- 
sioued tlie fever. This important conclusion, my readers will, I hone, bear in mind, till I 
can resume this topic. 

* This mention of the Court of Aldermen made me wish to have the books of that 
court examined ; and a gentleman, who by his office, had access to them, obligingly look- 
ed them over for the whole time bet-ween 1743, an<l 1770, without, being abic to find any 
entry respecting this subject, or tbe health of the prisoners, except son*e orders for the 
payment of money, for putting up and working a ventilator at Newga'e-, which was done 
in consequence of the sickness in question, under the direction of the Rev. Dr. Hales and 
Sir John Fringle. 



440 

hlc part of Sir John Pringle's account of it, he adds, " As the most 
putrid vapours are the most subtile and volatile, so I observed them 
to be in the court, at the Old Bailey, May the 11th, (erroneously 
adopting Sir John Pringle's date) 1750, when I was obliged to be 
there, and found the smell of the air in the gallery on the right side 
of the court, sensibly more offensive than below, when I was called 
down among the crowd to give evidence. And accordingly, those 
Who were situated highest in the court, as the Lord Mayor, Judges 
Middlesex Jury, and those in the gallery on the left hand of the 
court, were chiejly infected with the fatal contagion ; on which (left) 
side a wide sash-window facing the Judges was often ; at which an 
Easterly wind entered, which might blow down the most venomous 
vapour which was near the ceiling,* and condense, in some degree, 
and check the subtile infectious vapour, heated by a crowded court 
for many hours, from ascending so fast from among those on the 
bench, and in the left hand gallery : whereas, on the right hand, 
where no window was often, the same heat might cause the enven- 
omed vapour to ascend quicker to the lofty ceiling ; as it r> well 
known such vapour* constantly do in rooms ifull of crowded assem- 
blies." 

Assisted by these statements and explanations, I will now proceed 
to overthrow the baseless fabrics, to erect which so much labour and 
liiity have been wasted 

Those who ascribed the fever in question to jail infection, must have 
supposed, and ought to have proved, either that the prisoners by whom 
the contagion was said to have been diffused in the court, were then 
actually labouring under jail fever, and capable of generating its con- 
tagion, or, that this contagion existed so copiously in the place whence 
they had been brought into the court, (Newgate) as to infect i: 
clothes sufficiently to enable them to infect others at the distance of :5 
feet, which seems to have been the space between the Lord Mayor's 
seat, and the box allotted to the prisoners on trial. (See the plan.) But 
it is not known that any of the prisoners who were brought into court 
had any sort of febrile indisposition, nor is it known that any case of 
jail fever then existed, or had recently existed, even in Newgate. In- 
deed, the contrary seems to have been generally admitted and believ- 
ed, and with great reason; because, after so many persons were at- 
tacked with fever, in consequence of their attendance at the Old Bai- 
ley, on the 26di of April, so much attention was excited and directed 
to the state of Newgate, that if any thing resembling jail fever had 
been found in a single case, it would have been reported and made 
known ; instead of which, we only are told that upon an examination* 

• It is truly wonderful that Dr. Hales, who, on other occasions, and partkol 
156, has justly observed, th:tt the " ■Qatar heavier eal ' by rushing into a v 

room, displaces, and threes upwar ds the lig 
lo deceive himself, and reconcile his own • 

any one pour qukJcaUver into a tube spirit of wine, sod * 

when it enters at the top, will remain uppermost, and press down the Int. <«*»- 

in<; concerning what happened on the right side of tl 

Bays the sir on that side, am! especially la the gallery, was sacwf) oCesssil 

and, therefore the " infectious vapour'" ought to ha>c been there most abuiuL 
a.11 the mischief was done OB the opposite side. 




/'/an of the (>!<{ Badey.as it existed previously fe ih destruction during the rwls m /;*,> 
copied exactly from the onainal JMnriuo in the noiscfsion c*fWy r-ZhfnnrJTl f_f\ irtillif 

or Herb of the Works Jv the (ily of London .by whom this (o/>v nw./nw to die Autfior 
.YJ The divisions wxlhin the Court-Hall ,ire maArd acvniina to its present state . hut 
the Author has been informed bv Jf Dance that these do not differ or. at least not ma 
tenalh. trout those which existed in the former Buddtna 



EXPLANATION of the PLAN of the OLD BAILEY. 

a Covered passage, by which the prisoners are brought from Newgate 

to the Old Bailey, 
b Bail Dock, in which the Prisoners are kept till they are called into 

Court, 
c Small Door, (under the Window) by which Prisoners enter the 

Court from the Bail- Dock, pr eparatory to their trial, 
d Place where they stand before they go into the Prisoners box. 
e Box for Prisoners under trial. 
f Bench for the Lord Mayor, Judges and Mdermen. 
g Places of retirement from that Bench, taken from the corners of 

the room. They are about seven feet high, and that on the right 

of the Court is left open at top. 
h Boxes for the Sheriffs. 
i Bench for the Counsel. 
k Table for Do. 
I Spaces serving as passages, 
m Box for the Middlesex Jury, 
n Box occasionally used for the London Jury, 
o Boxes or Seats for Officers, Clerks, <$* c. of the Court. 
p Box for Law-Students, <Jj*c. 
q Box for the Witnesses. 

r Standing place for persons who attend to prosecute or give evidence, 
s Columns. 

t Doors opening into different parts of the Court 
u Windows, of which the three facing the Judges are large Sash- 

Windows, 
x Passage outside of the Courts over which are the Galleries for 

Strangers who come to hear the Trials. 



441 

it was found that the prison, " and the passages leading thence into tlie, 
court, were in a filthy condition." It has been asserted, however, that 
though there was then no case of jail fever in Newgate, there might 
be such a remnant or accumulation of febrile contagion formerly ge- 
nerated there, as to contaminate the clothes of the prisoners, and ena- 
ble them to infect the court, without being themselves made sick by 
that concentrated infection, which, even when diluted and diffused, 
was still powerful enough to cause the deaths of persons at a conside- 
rable distance ; and such assertions have been adopted and repeated 
under the sanction even of great medical authorities : and the better 
to account for this wonderful immunity in these distributors of deaths 
it has been pretended, that persons might gradually acquire the habit 
of bearing unharmed the impressions of that contagion, which has 
proved so destructive to others ; and, therefore, that we are not to 
conclude, that febrile contagion did not exist in a very concentrated 
and virulent form in Newgate, from the circumstance of its not having 
occasioned sickness to any person who was confined therein. In my 
judgment, however, these assertions and reasonings, as applied to the 
contagion of typhus fever, have no foundation in truth, .ill our ex- 
perience proves, that the longer persons are exposed to the action of 
this contagion, the more, certainly, will they be attacked by the fever : 
that the escapes of medical men are entirely owing to their remaining 
but for a short space within its reach at any one time : that persons 
who may resist its impressions for a day, are not likely to resist them 
for a week ; and that those who resist them for a week, will rarely con- 
tinue to do it for a fortnight : — I mean in places where the contagion is- 
not dispersed and rendered innocuous by frequent changes of the at- 
mosphere. But even if the assertions which I am now controverting 
were true, they would not answer the purpose for which they were em- 
ployed, in regard to the events of the Old Bailey sessions. Sir John 
Pringle, in a note to p. 330, mentions what is indeed generally known, 
that "it has been the custom some days before every sessions,, to re- 
move all the malefactors from other gaols into that of Newgate." And 
this appears to have been done previously to the sessions in April, 
1750; and as the persons thus removed could not have gradually ac- 
quired the supposed habit and power of bearing the contagion alleged 
to have been at that time accumulated in Newgate, they must have 
been as liable to its morbid influence, as those who were said to have 
been infected by it at the Old Bailey, and infinitely more so, because 
they must have been exposed to it at the source, and in its most con- 
centrated form ; whilst the latter could only have received it at a second 
hand, when diffused from the clothes of prisoners, and greatly diluted. 
And as none of the persons so brought into Newgate appear to have 
been attacked with jail fever, either before or after the sessions, there 
is the strongest reason to believe that no such contagion at that time 
existed in Newgate, Sec. consequently that none could have been car- 
ried thence to infect the court at the Old Bailey. 

But if we were to suppose (for the sake of argument) that the jail 
fever did at that time prevail in Newgate, and to as great an extent as 
it was ever known to have clone, there would still be good reason t» 

56 



442 , 

conclude that it did not occasion the fever which was consequent upon 
Capt. Clark's trial. 

In a note to p. 438, I found sufficient ground for concluding, that 
whatever the cause of that fever might be, it must have been con- 
tained in and applied by the stream of cold air which entered by the 
open window, and reached the persons who, being placed in that par- 
ticular direction, were afte rw ar ds exclusively attacked with the dis- 
ease. This was also the avowed opinion of Sir John Pringle and Dr. 
Hales. But if we suppose the jail infection to have been brought into 
court by Capt. Clark, (a strange supposition considering his rank in 
life, and the cleanly decency at least, with which he must have been 
clothed) that contagion would have been much more likely to operate 
previously to the opening of the window, when, as there was little or 
no circulation of air, it would have been less diluted; but if it had 
operated at that time, its operation would not have been directed and 
limited to those particular persons on whom the cold easterly wind 
afterwards blew, but to those who were nearest to him on all sides ; 
and we may therefore presume, that the fever in question was not oc- 
casioned by any application of jail infection, previous to the opening 
of the window, and certainly it could not have been produced by that 
cause after the admission of such a strong current of air, as must by 
its quantity and coldness have so much diluted, elevated, and dis- 
persed the contagion, as to render it harmless, even if, in addition to 
Captain Clark, scores of prisoners had been in court.* 

Another insuperable objection to the supposed production of this 
fei er by contagion arises from the space between the bench on which 
the judges were seated, (where the cause of the disease proved mor- 
tal to four out of six then present) and the box wherein the Priaoi 
are plated when under trial, and which is the nearest approach die] 
ever allowed to make towards that bench. This distance, as I 1. 
already mentioned, and as will appear by the engraved plan of the hall, 
is about twenty-five feel; ami we are warranted by all the experience 
of modern times in beii< .1 or typhus fei 

from a person acti ftse in its worst form, will not pro- 

duce fever in other persons at the distance of three yards, in a room 
of moderate dimensions, where the air was not previously infected. t 

* Had there been any contagion in Newgate capable of infecting the court at the Old 
Bailey, we might have justi\ expected thai it would hare done so on the fir>; 
win n more tlian twice as many prisoners were tried, and when no window appears ta 
bate been opened, to Dilute and disperse the infection. It is not, howerer, prett 
that the jail infection operated at any time during tin uhea. 

a stream of cold air was admitted, sufficient of itself to pro' 'iout 

any aid from contagion, and sufficient ako to render t 
been present. 

f Dr. Haygartb,in his letter to Dr. Peroral, on the Prevention of infections fci 
(Bath, 1801,) sgys, im^e 8, u In 177,". I began to ascertain, hi c'inical observn: 
according to what law the va riohm infection, and in 1780, according ta what law the 
febrite infection is propagated. 1 fouud that the pernicious t he variolous mi- 

asm were limited to :i very narrow sphere In the open air, and in moderate cases, 
f discovered that the infectious distance d c it is pro- 

bable, that eten when th< influence extends but 

a few yawls from the poison I *oon, aUo, discovered that the contagtin o/ /ever* was 
con fned to a much narronver sp/tere." 1 



443 

With this knowledge of the very limited action of the contagion of 
jail or typhus fever, when present, and \-Xkh so many valid reasons for 
believing that none was p-resent, at the sessions, the 26th of April, 
1750, we are certainly bound to ascribe the fever which was a conse- 
quence of that session, to some other cause ; and none presents itself 
so obviously, and with so many probabilities, as that which Sir J.Pringle 
thought proper to reject; I mean the sudden admission of a continued 
stream of cold air, impelled forcibly by the external wind, upon per- 
sons who had previously been greatly overheated, and were conse- 
quently in that state which renders a sudden and copious application 
of cold, either externally, as on that occasion, or internally by large 
draughts of spring or iced water, in very hot weather, or by the eating 
of iced creams, &c. in particular circumstances, so often productive of 
a mortal disease. Even Dr. Hales was aware of danger from a free 
admission of fresh air by ventilation, as may be seen at p. 144, 153, 
and 155 of the work lately quoted, and at the last of these passages, 
after representing <* it as a matter of great importance to use means 
to change the air in crowded rooms, he adds, that this must be done 
by a constant gentle succession of fresh air;" which " must not be let 
in at open full windows, especially in cold weather;" and this injunc- 
tion he repeats in other places. Almost all the circumstances which 
are known to render the application of cold hurtful, seem to have co- 
operated at the Old Bailey, during Capt. Clark's trial, particularly the 
length of time in which its application was continued; its being ap- 
plied by a wind, or current of air; its being a transition or sudden and 
considerable change from heat to cold; and its being applied partially 
to a particular part of the body, while the rest was kept in greater 
warmth than usual : we know but little of the causes which might have 
assisted to produce debility on that occasion, and thus to render the 
impressions from cold more injurious ; excepting that of fasting, 
which, from the duration of the trial, must have been unusually pro- 
longed ; nor are we acquainted with what might have happened after 
the court had adjourned, to increase the morbid influence of the cold, 

In a report made by the committee of the dispensary at Newcastle, publisher! in Dr. 
Clark's collection of papers respecting fever wards, (Newcastle, 1802) the following 
paragraph occurs, at page 1-2, viz " The most malignant fever does not render the at- 
mosphere infectious farther than a few feet from tlie patient, orfcomtfie contagion present- 
ed in clothes, furniture, &c. and daily observation confirms, that a person wist remain a 
considerable time ivitidn the spliere of infection to receive it ; for physicians and surgeons, 
who avoid the current of the patient's hreath, and the effluvia arising- from his l>ody 
tvitliin the bed-curtains, do not receive the contagion in their ordinary v sits ; and they 
never convey it to others ; the infectious effluvia, received in their apparel, heiug spee- 
dily rendered innoxious by being diluted with pure air." In a report, also, from the 
institution for the cure and prevention of contagious fever in the metropolis, May 5th, 
1805, it is stated, that " the house occupied for the purposes of the institution stands in 
the midst of a row, in contact with dwelling houses on both sides; that 420 pati- 
ents" (with typhus fever) "have been received into it," &tc. •* yet the neighbourhood 
has continued altogether free from the disease," kc After which the following ohs-r- 
vation is added, viz. " Were not the general prejudice on this subject strong, this 
fact, indeed, might have been clearly anticipated. For if, as we have learnt from ex- 
perience, contagions, diluted by the free admission of air, are not communicated from 
room to room in a house nor even from bed to bed in the wards of an hospital, it 
scarcely required a positive experiment to prove, that houses even in contact, rry. 
not liable to infect each other." 



444 

^"bich had been already applied. We know enough, however, to make 
it probable, in the highest decree, that this was the cause oi the fever 
which ensued, and proved mortal to so many persons. Sir John Prin- 
gle has, indeed, delivered an opposite opinion, but on grounds which, 
in my judgment, have little solidity; he observes, in the note lately 
quoted, that the window which admitted the cold air. t the 

farthest end of the room from the bench, though the judges suffered 
mil;" it should, however, be remembered, that this window was 
much higher than the heads of any of those who were on the left hand 
side of the court, and, consequently, that the stream of cold air p, 
harmlessly over those who were nearest to the window, and, gradually 
descending by its superior gravity, went uninterruptedly, and with full 
force, to the j n that side) who being most elevated, were most 

exposed to its impressions, though forth. the window ; a cir- 

cumstance which Sir John Pringle did not think of any importance, 
though immediately after he stated it as probable that the air from 
the window directed the fiutrid streams to /hat part of t! here 

the judg, rated" Certainly, if the current from the window 

was sufficient to convey the supposed putrid or infectious matters to 
the judges, it must have been sufficient also to communicate the effects 
of its own diminished temperature or coldness. 

In regard to Ins other ground, viz. that neither " the kind of fever, 
nor die mortality attending it," could M be attributed to a cold . 

oswered that they arc much less attributable to jail infection. 
Unfortunately, we know but little of the u kind of fever" then pro- 
duct d; a circumstance for which Sir John Pringle himself is blame- 
able: for, though he appears never to have seen a case of it, he 
might easily have procured, from other physicians, a sufficient ac- 
count of its symptoms, (which Mr. Foster states to hai Much 
alike in all the patients,) and have enabled us to judge how far they 
were similar to those which he has described as belongir. 
fever. But without doing this, he admits that u It 
fever in the beginning had an inflammatory appearance," which ifl 
actly that of a fever from cold, and the very fa jail fever. In 
opposition, how ever, to this admission, he adds, " that after large 
evacuations the pulse sunk, and was not to be raised again by blis*. 
nor cordials, and the patients soon became delirious." It will not, I 
presume, be expected, that I should undertake to account for parricu*- 
lar effects, loosely stated on the ground of hearsay, without any com- 
munication of other facts and circumstances, which, if known, might 
probably remove all difficulty and obscurity respecting them. I m 
therefore, only observe, that I do not consider it as necessary, that 
fevers produced by the sudden application of cold, should, in all cir- 
cumstances, ages, and constitutions, bear large (probably c\< 
evacuations, without a sinking of the pulse, or without subsequent 
delirium. And in regard to fietech'nt, which were reported to ha 
been observed in some few cases, I need only refer to p. 97 of the Ap- 
pendix to Sir John Pringle 's work, where he notices, " the undeter- 
mined meaning of the word Petechix;" adding, its " ambiguity is 
such, that I must regret my having at all used the term." The au- 
thor had before said, in the preceding page, that even these spots 



445v 

which he had called petechia, though sometimes accompanying the 
jail fever, had no "title to characterise that disorder." 

Sir John Pringle also mentions that some escaped without a fever, by 
a " looseness coming on, which was easily cured." This fact I con- 
sider as eminently indicative of morbid affection from the applica- 
tion of cold, which is often observed to take tJiat covrse ; and by 
doing so, to obviate the occurrence of fever, and other worse conse- 
quences : but I have never known such an escape from typhus fever.— 
On the contrary, I believe that where a sufficient dose of that conta- 
gion has been imbibed, the supervention of diarrhoea from any cause, 
would render its operation in producing fever, more sfieedy and cer* 
tain, by inducing debility. 

It is much to be regretted, that neither Sir John Pringlej nor any 
other writer within my knowledge, has stated the precise interval 
between the trial of Captain Clark, and the commencement of fever in 
any one of the persons then present. He only mentions that none were 
taken into his account who did not sicken within the first fortnight after 
the sessions. With this latitude, there might have been barely time 
for the production of fever by jail infection. But, though this was 
the longest interval, they might, for any thing which he says to the 
contrary, have all sickened within half the time, and that, in my judg- 
ment, would have afforded the most decisive proof of a different fe- 
brile cause ; and this probably was the fact, at least in some of the cases ; 
though the extract which I have given from Foster's Reports, &c. is 
almost as vague on this point, as Sir John Pringle's statement; for it 
pnly asserts, " that within a week, or ten days at most, after the ses 
sion, the persons in question were seized with a fever," Sec* 

In rcgard^o the mortality from this fever, which Sir John Pringle 
thinks too great for a fever from cold ; he surely ought to have re- 
collected, that this objection would apply with greater force to his sup- 
position, that the fever had originated from contagion ; for the most 
concentrated or virulent jail infection ever known in this country, did 
not, so far as I can recollect, produce a fourth part so many deaths 
among an equal number of sick ; and it therefore must be incredible, 

* We are left in equal uncertainty concerning the time w-iich the disease had subsisted 
even in a single case, before its fatal termination. We are only informed by the Lon- 
don, Gentleman's, and Universal Magazines, for May, 1750, of the days on which 
most of the persons died, with intimations of their having been at the preceding Old 
Bailey sessions. The London Magazine mentions Sir Daniel Lambert, and one or two 
others, as having died on the 13th of May, and other deaths as occurring on nearly 
all the succeeding days, until the 21st. The Obituary of the Gentleman's Magazine 
states, "Sir Daniel Lambert, knight and alderman," to have died on the 13th, "of 
a violent fever" which certainly is not a description of typhus. 

Dr Adams (misled by Sir John Pringle, in regard to the commencement of the 
sessions,) states in his Inquiry into the Laws of Epidemics, (p. 12 and 13) that on the 
11th of May, 1750, the prisoners at the Old Bailey were sufficiently in health to attend 
their trials ; yet, from the effluvia they brought with them on tlie 13th, died one magis- 
trate, on the 14th the undersheriff, on the 17th one judge," &c. Here Dr. Adams mani- 
festly believed, and intended that others should believe, that the effluvia supposed to 
have been thus brought into court on the 11th, had not only produced a violent dis- 
ease, but that this disease had also proved fatal, all in the space of 48 hours from the time 
of its communication. A monstrous error: it being probable, that jail infection never 
produced disease and death in so few weeks as the number of days in which the doctor 
supposes all this to have happened. 



446 

fliat such unexampled mischief should have been occasioned, where 
the febrile contagion, supposing it to have existed, ivas too iveuk to pro- 
duce disease, even in those who were said to have brought it into 
court, or in Newgate, whence it was said to have been derived. And, 
though the mortality in question was greater than I should have ex- 
pected, from a fever produced by the sudden application of cold, yet, 
so many things are capable of increasing and aggravating the morbid 
effects of that cause, particularly by inducing local and mortal inflam- 
mation in some important organ or viscus, that it is much less surpris- 
ing that a fever so produced should occasion an unprecedented mor- 
tality than it would have been, if so many deaths had resulted from a 
jail or typhus fever. 

I have not insisted on the non- communication of the disease by any 
of those persons who sickened after being at Captain Clark's trial, 
because that fact, though it increases the probabilities, does not af- 
ford any decisive evidence that the fever -was not a typhus, as most 
of the sick were above the ordinary class, and may be supposed to 
have occupied apartments so large, that the propagation of the fever 
was not a necessary consequence. 



APPENDIX. 

No. V. 



The author* at p. 119, intimated an intention of inserting in this 
Appendix certain extracts from the " Memoires sur les Hospitaux 
de Paris, par M. Tenon," respecting the Hotel Dieu of Paris; but 
the editor Jinds it 7ieccssara to refer those to whom these extracts 
might have proved interesting, to M. Tenon's original work, particu- 
larly to the pi-eface, and to pages 135, 138, 141, 163, 165, 194, 
19T, 198, 199, 207, 208, 209, 22S, and 28r. 



APPENDIX. 

No. VI. 



The author, at p. 151, has referred his readers to this Appendix, 
" for Proofs" of the " Exemption of the inhabitants of (or adjoining 
to) Peat Bogs from Intermitting Fevers. " The same necessity 
which compelled the editor to omit what was intended to constitute 
the preceding Appendix, (i. e. the unusual number of pages to 
which the volume has already extended) has determined him to refer 
the reader to Dr. Jameson's Mineralogy of the Scottish Isles, vol. 2, 
p, 127 ; and to the Essay on Peat, by the Rev. Dr. Walker, Professor 
of Natural History, in the University of Edinburgh, — published in 
the Transactions of the Highland Society of Scotland, vol. 2, p. 23. 
The author had moreover intended to place in this Appendix certain 
MS. communications stating the non-occurrence of marsh fevers at 
Strabane, and some other places in Ireland, adjoining to Peat Bogs, 
except in persons who had previously been exposed to marsh miasms, 
by residing in other situations. In such persons, particularly one 
from the state of Maryland, intermitting fever is stated to have oc- 
curred some months after leaving America, and to have proved very % 
obstinate. 



APPENDIX, 

NO. VII. 



Having explained the purpose of this Appendix at pages 203 and 
204, and meaning to leave no doubt subsisting in the mind of any per- 
son qualified to decide on the credibility of Dr. Chisholm's account of 
the supposed generation of a new Pestilential Fever on board the ship 
Hankey, on the Coast of Africa, I beg leave to premise a short, but 
faithful statement of the transactions which are supposed to have been 
Connected with that monstrous Production) founded principally upon 



448 

the African Memoranda of that very intelligent and meritorious offi- 
cer, Captain Beaver, of the Royal Navy;* and upon authentic docu- 
ments, published in Wadstrom's Essay on Colonization. 

Several gentlemen having associated for the establishment of a co- 
lony at the island of Bulama, near the mouth of Rio Grande, on the 
Coast of Africa, and obtained the approbation of government, a num- 
ber of colonists and labourers were engaged, and embarked in two 
chartered vessels, viz. the Calypso, of 298 tons, and the Hankey, of 
260 tons, besides a sloop of 34 tons, purchased by the association; all 
of which, with sufficient stock of provisions and stores, sailed from 
Spitbcad, on the 12th of April, 1792: the Calypso having onboard 
149 settlers, or eolonists, consisting of men, women, and children; the 
Hankey 120; and the sloop 6; making in the whole 275. These! 
sels Avere, however, separated in a few days, by a storm, and the Ca- 
lypso having touched, on the 3rd of May, at Tenerifle, and on the 12th 
at Gorce, proceeded to Bulama, and on the 25th of that month anchor- 
ed in a harbour, at the western extremity of the island, where the 
vernor of the new colony, Mr. Dalrymple, determined to wait for 
arrival of the Hankey, on board of which was the investment for pur- 
chasing the island, and trading with the natives. But in the mean 
time, he imprudently landed, with some others, to explore th< 
while, as Captain Beaver informs us, (at page 46 of his Afi 
moranda,) several of the colonists erected small huts and ten 
shore; parties wandered wherever they pleased in the day, and re- 
turned to the ship, or«not, as they thought proper, in the evening. In 
short, nothing," adds he, kk could be more irregular, or improper 
their conduct. In this disorderly state, they were on the 3rd of June 
surprised and attacked by a party of Bijugas, a warlike tribe 
cans, inhabiting the neighbouring island of Canabac, (to whom Bulama 
then belonged, who killed live men and one woman, wounded fouF 
men, and carried off' four women and three children. This div 
which had resulted from a mistaken notion in the natives, that the 
colonists had come to dispossess them by force of their territory, I 
cd so much alarm among those who had escaped, that they re-em- 
barked immediately, and sailed on the 5th for Bissao, a Portuj 
settlement on the coast, at a small distance. But on their way thither, 
finding the Hankey was ]\\*i arrived in the Bijuga channels, they joined 
the latter ship, and on the 8th of June, both ships, with the sloop, pro- 
ceeded to the road of Bissao, where they anchored. By this tinu 
Captain Beaver informs us, p. 58. " the Calypso had many persons 
on board ill of /ever, though none had yet died of it;" besides which, 
he adds, " nothing was heard but mutual reproaches from the people 
of the Calypso. The colonists accused the members of the council in 
that ship, of a want of attention to their comfort and accommodation : 
(those in the Hankey having fared better than themselves, by procuring 
supplies of fresh provisions at Tenerifle and St. J ago.) Tl 
tired out with the length of the voyage ; irritated by the loss of 

* At p. 94 of his Letter to D^ Haygarth, Dr. Chisholm, a'ler mentioning C 
Beaver's publication, rieteribi complete ami oiivunisunnal narrs. • 

llio wlmli- of then ■ iirin-i«cilin£s;" (those of thr Hftftkej ami thu BnftNMkOOli -• 
.« executed " with a candour ami nairete, which stamps it • 



449 

friends, in the recent attack of the natives, and the disappointment of. 
their hopes. On the junction of the ships, these discontents were 
speedily communicated to the colonists on board the Hankey : Captain 
Beaver, who had made his passage in that ship, says, that he had " left 
her on the 5th of June, a quiet, clean, healthy, and orderly ship ;" but: 
at his return, on the 7th, he found her " a noisy, dirty, disorderly ship ; 
the colonists dissatisfied and dispirited." 

During their stay at Bissao, Captain Beaver mentions the fever to 
have appeared on board the Hankey; and that on the 21st of June it. 
" still continued in both ships, but only one person had yet fallen a 
victim to it in the Calypso, and none in the Hankey." (Page 60.) 
Soon after the arrival of the ships at that settlement, agents were sent* 
to the island of Canabac for the purpose of ransoming the women and 
children taken prisoners at Bulama, which was accomplished on the 
19th of June; and the willingness of the Bijugas to sell the latter island 
having been ascertained, the ships quitted Bissao on the 21st of June* 
and anchored on the 27th in a line harbour, in the East Channel, be- 
tween Bulama and the Biafara shore, opposite to the spot on which the 
settlement was subsequently fixed ; having previously dispatched Cap- 
tain Beaver with Mr. Dobbin to Canabac, where they speedily con- 
cluded a treaty, by which the island of Bulama was purchased for 473 
bars, worth from 120 to 140 pounds sterling. In the mean time, how- 
ever, the discontents had increased among the colonists ; " the major 
part of whom," Captain Beaver describes (in a letter addressed to the 
Trustees of the Bulama Association in London, dated from Bulama, the 
22d of November, 1792, and printed at page 300 of the second part of 
Wadstrom's Essay on Colonization,) as being" drunken, lazy, dishonest, 
and impatient;" and the setting in of the rainy season, which began 
on the 4th of June, with the prospect of great fatigues and privations 
to be undergone during that season, had probably contributed not a 
little thereto. In this state of mind, a very considerable number of 
them resolved to abandon the colony, notwithstanding the success of 
the negotiation with the Bijugas. Accordingly, sixteen ot them sepa- 
rated almost immediately; and others, to the number of 117, (among 
whom were the governor, Mr. Dalrymple, and the lieutenant-governor,- 
Mr. Young,) sailed from the Bulama in the Calypso, on the 19th of 
July, for Sierra Leone, and thence to London, where they arrived in 
the middle of November, excepting about 40 who died from sickness. 
The state of both ships, in* regard to health on the day of the Calypso's 
departure from Bulama, is thus mentioned by Captain Beaver, at p. 
80 of African Memoranda; — " 19th of July. The fever had hitherto 
continued in both ships; the Calypso having buried three who had 
died of it since we had left Bissao, and sailed with many sick. The 
Hankey had buried three also, and had now two colonists, and three of 
the ship's company labouring under that disorder." 

Upon the departure of the Calypso, with governor Dalrymple, &c. 
the remaining colonists, consisting of 48 men, 13 women, and 25 chil- 
dren, elected captain Beaver to be governor, and his conduct, amidst 
the numerous difficulties and distresses by which he was continually 
surrounded, until compelled to abandon the island on the 29th of No- 



450 

\ ember, in the following year, appears to have been in all respects 
highly commendable. The first and principal undertaking of the new 
colonists, was that of building a block-house for their protection and 
accommodation, upon the summit of a hill near the harbour, which 
was then "covered with a thick forest." See p. 93. But, having no 
sort of accommodation on shore, they were constrained to live on 
board the Hankcy ; and the beUer to defend themselves from the 
rains, 8cc. they erected a covering to the ship's deck. Their only 
shelter, on the island, was " a little tool-house," and as the heavy 
rains made it impossible to dress their victuals on shore, the working 
people were landed on the island at day-light every morning', and 
brought on board to breakfast, at 8 o'clock ; carried back to their work 
at nine; brought on board to dine at noon; again relanded at 2, P. M. 
to resume their labours; and, finally, brought on board to sleep at sun- 
set. In this manner they continued to work through the rainy s< 
(which ended about the 15th of October,) and afterwards until the be- 
ginning of November; when the time being expired for which the 
Hankcy had been chartered, it became necessary to land the colonists 
with all their stoics, to enable the ship to prepare for her departure, 
although the block -house could not be finished until the month of 
Febru 

On the 23d of November, the Hankcy sailed from Bulama, having on 
sixteen of the colonists; viz. 7 men, 4 women, and 5 chil 

v. At this time the colony had sustained a loss, subse- 
quently to the Calypso's departure, of 48 persons by death, of 
23 are stated to have died of fever ; one by w fever and flux. 
other specified diseases, hurts, and accidents-. On the 26lh of N 
her, the Hankcy anchored at Bissa ence for England on 

of December, but in the night of the 4th she grounded on 
bank near the island of V which made it 

part of her crew in the pinance (an open boat] to Bissao for 

ird rowing for two days and I 
:id long ' their he! 

■rain* made to float : but on 1 ople who 

-.en ill." On Uu* 13th the Hankcy 
■-•ought back to Bis- t finally sailed thence on the 

2 1st oi <t, and anchored in St 

the 26th of that month ; where I shall l< 
enter upon an inquiry into the causes and nature of 
had been so prevalent, while she remained at Bulan 
which) lUme have hitherto 

that parr of Africa, nothing but Dr. Chishohn's confident, though un- 
warrantable statements, could have ma 

It has been already mentioned that the Calj cd at Bula- 

ma fourteen days before she rejoined the Hankcy in the Bij 
nelsin which interval, the colonists tired of their confinemei 
board, and believing they had now reached the land*of promi> 
wandered about that island in the most urn and imp: 

manner, sometimes sleeping on shore, and t 



451 

selves most incautiously to the action of marsh miasmata,* until they 
were surprised, and partly cut oft', by the Bijugas. Those who have 
lived between the tropics, or who have read of the numerous instan- 
ces of mortal fevers which have been there produced by sleeping a 
single night on shore, will not be surprized that after such conduct, it 
should have been found, as is mentioned by Capt. Beaver, that on the 
8th of June " the Calypso had many persons ill of fever :" nor that this 
fever should have been, as will be incontestably proved, the common 
marsh, intermitting or remitting fever of the coast, and that the same 
fever should have appeared in the Hankey some time after her arrival 
at Bissao ; a place where this " coast fever" is known to prevail in 
the rainy seasons, (which had then recently begun) and where during 

• Dr. Chisholm, at p. 103 of hisJetter to D. Haygartb, says, rt In every instance of great 
mortality on the coast of Guinea, and in many other countries o! the old and new continents 
•within the tropics, (and there are many dreadful ones given by Dr. Lind and others J 
the cause lias evidently heen marsh miasmata, or an " inland impure atmosphere, loaded 
with stinking sulphureous mists." Yet, indirect opposition to this assertion, he immedi- 
ately after, endeavors to maintain that the mortality on hoard the Calypso and Hankey 
did not result from this cause, but from one which certainly never did produce "great 
mortality" between the tropics ; 1 mean febrile contagion ; and for this purpose, he alle- 
ii< s that Uulama, " is e\ery where surrounded by sea, is no where marshy, gradually ri- 
ses to a moderate elevation immediately from its shores, is blessed with abundance of 
running water, and with a soil rich and prolific, affording ample pasturage to innumerable 
wild animals." Had it however suited Dr. Chisholm's purpose, I am persuaded that, 
even supposing this description to be accurate, (whieh 1 do not believe) he would, not- 
withstanding, have readdy discovered sufficient sources of marsh miasms at Bulama. Its 
being surrounded by sea is no obstacle to their production ; witness the islands of St. 
Thomas, Batavia, St. Lucia, St. Domingo, and scoies of others, which are extremely un- 
healthy ; and in regard to its " rich and prolific " soil, Uulama, in this respect, only re- 
sembles the country along the banks of the Guadalqmver, in Andalusia, the Terra di 
fjrvoro near Napfeft, and other places already mentioned, as being eminently produc-. 
tive of marsh fevers. Governoi Dalrymple, and the council, in their joint letter to the 
trustees of the Bulama association, say, "the island, we learn from the gentlemen who 
have explored it, has extensive savannahs, of a deep black mould." See Wadstrom's Es- 
pfj on Colonization, 2d part, p. 144. And governor Dalrymple, in a separate letter, 
quoted in the preceding page, says, " the north end of the island, is one continued savan- 
nah, covered with long grass, with a few trees interspersed, but without any rocks or 
stones/' He adds, " the soil of this plain \s-deep and rich " Now, it is utterly impossible, 
that such a soil, in such circumstances, should not be greatly productive of morbific ex- 
halations, in that climate, whenever (by showers or otherwise) there is sufficient mois- 
ture for their extrication, and besides these savannahs, it is incredible that the shores of 
such an island, and especially its harbours, should not in a multitude of places be fittedto 
produce and give out marsh effluvia copiously : there not bJtmg, so far asl can discover, 
one situation in that part of Africa where a ship can anchor near the shore and remain 
even for a week, during the rainy season, without some of hev crew being soon after at- 
tacked by marsh fever. Such, however, was Dr. Chisholm's anxiety to persuade others 
that in this respect, Bulama differed from every part of the co ist, that (at p. 118 of vol. 
i. of his Essay) he has introduced a quotation from the '* Voyage de Chevalier des M.-irchais 
(en Guinee and isles voisines) ' which, besides its being otherwise of little importance, 
relates entirely to the islands in the river of Sierra Leone, and not in the smallest degree 
to Bulama, which is in the Rio Grande, and distant more than i'00 miles He mak« s a 
similar mistake by quoting Dr. Lind, who has not once mentioned the islands in Rio 
Grande. I may add that Dr. Chisholm's anxiety on this subject has also led him to ad- 
duce the testimony of Mr Paiba, ( which admitting it to be correct as far as his know- 
ledge extended, amounts to very little) though in many other parts of bis writings Dr. 
Chisholm earnestly endeavors to impeach Mr. Paiba's veracity, and as I think, with very 
little reason ; for though his communications to Dr. Smith, were not aU.correet, in re- 
gard to dates and numbers, (he relating them from memory only, and after an interval of 
four years) his statements in other respects have been generally confirmed by other evi- 
dence, and he has no where made such groundless misrepresentations, as those of Di\ 
Chisholm, nor indeed any which manifest an intention to mislead. 



452 

her stay of 14 days, it may be presumed that the drunken, dissipated, 
and vicious characters mentioned by Captain Beaver, as being a ma- 
jority of the colonists, would have freely indulged their dissolute pro- 
pensities,* in aid of the morbid influence of mash miasms ; but though 
these vessels afterwards proceeded to the harbour, adjoining to the 
spot destined for the settlement at Bulama ; yet by reason of the in- 
tended departure of the adventurers, very little work was done on shore 
during this interval ; and the fever, being void of contagion, did not 
spread in the ships ; as only five persons Mere ill of it on board the 
Hankey, when the Calypso quitted Bulama on the 19th July. After 
this time, however, all the remainurg colonists, able to work, were con- 
stantly employed in laborious occupations on shore, for 9 hours daily, 
and were often caught, as is mentioned by Capt. Beaver, in very heavy 
showers of rain, than which few things can be more dangerous in that 
climate ; and they must also have been greatly exposed to the marsh 
miasmata constantly emitted in that rainy and sickly season. These 
causes, joined to their general despondency, and various hardships, pro- 
duced, as might well be expected, such an increase of sickness, that, 
as Captain Beaver mentions at p. 137, "every person employed about 
the block-house was ill and unable to work" on the 17th of Septem- 
ber; 

Dr. Chisholm has, in various places, stated his opinions of the 
causes of this fever, though with some variety, and often with no little 
obscurity : that statement, however, which seems to have obtained his 
last correction, may be found in his letter to Dr. Haygarth, in which, 
at p. 103, after asking, "what were the causes of this fever and mor- 
tality," he says, " all the causes which generate infectious or pesti- 
lential fever, is the obviqus answer." Now, though this answer may 
satisfy some of those who believe that there are such causes, it is far 
from satisfying me, who (for many reasons already stated) have no 
such belief; especially, as though assuming the presence of all these 
supposed causes, he has omitted to designate, and establish the exis- 
tence of any one of them. He has, indeed, attempted to prove that 
the fever in question was infectious, and for this purpose (at p. 99 of 
the letter just quoted) has availed himself of a passage in captain Bea- 
ver's African Memoranda, (p. 54) where the latter, describing the 
transactions of the Hankey and Calypso, after their rejuncuon on the 
7th of June, says, " the fever from which the Hankey v>as still free, 
had already made its appearance in the former ship ; and, instead of 
separating the infected from the well, and taking any steps to prevent 
the spreading of that dangerous disease, by prohibiting any unneces- 
sary intercourse between the two ships, the whole time, since the ar- 
rival of the Calypso, had been taken up in the constant interchange of 
visits : nay, the affected themselves, die very persons who had the fe- 

* Wad strom, page 51 1, gives the following extract of a letter from Charles Drake, 
Esq. " We left the remains of several of our people at Balama ; but I know of none 
whose decease might not be accounted for, by their being- addicted to di'ink rum." 

Id page 113, Lieut, governor Young, in his" Return of the deaths of the Bulama Ad- 
venturers," states that, " ot the nine persons who died at Bulama, not one contracted his 
fever there, but all of them at JBissao, except those whobrought their disease from Eng- 
land. Of the remaining number, many caught the fever at Sierra Leone ? through intem- 
perance," &c. 






453 

-per on them at the time, had been actually on board the Hankey,* 
and the consequence was, that many days did not elapse before the 
fever made its appearance in that ship also." That captain Beaver, 
when he wrote this passage, (which probably was about the time when 
the transactions happened,!) did suppose the fever in question to have 
been communicated from the Calypso to the Hankey, is evident. He 
seems, however, to have thought so, from an erroneous notion (which 
has prevailed, in a great degree, even among medical men, and which 
captain Beaver might well have adopted) that all fevers were conta- 
gious, and that, as a matter of course, such a communication of fe- 
ver must have resulted from the intercourse just described. But there 
is good reason to believe, that he did not long retain this notion, but 
was soon convinced, by personal observation, that contagion had no 
influence in spreading the fever, (especially as, even on the 19th of 
July, only two of the Iiankey's crew, and three colonists, had any 
fever,) or occasioning the mortality which resulted from it; for he does 
not afterwards (according to my best recollection and belief,) even hint 
at the operation or existence of any such cause; but wholly omits it, 
in the various parts of his journal and official letters, in which he 
endeavours to account for the sickness and deaths, either of the co- 
lonists or of the Hankey's crew \\ nor did he, when he afterwards be- 

* This fact indicates, what will soon be proved, that the fever in question must have 
been a mild marsh fever, probably an intermittent, for under such contagious fevers as 
Dr. Chisholm supposes the Hankey to have drought to Granada, patients do not pass 
their time in going from one ship to another, to make or return visits. 

j" Capt. Beaver, at p. v. of his preface, says, " most of the circumstances preceding 
the l$th of July were written by myself, as the circumstances occurred;" and he profess- 
es generally to' have published his journal just as he wrote it, in order to exhibit the 
impressions on his mind, at the moment when each part was written. 

t To establish the truth of this allegation, the following proofs will suffice, viz. in a 
letter from Capt. Beaver to the Bulama trustees, dated November 22d, 1792, (see 
African Memoranda, p. 292) he writes, " the great mortality must certainly be attri- 
buted to the great labour and fatigue attendant on tbose who first attempted to settle 
a colony, and to the necessity we ivere reduced to of working in the rains, in order to 
have a foil to defend, and a house to cover us. With little strength, we found it ne- 
cessary to work from morn to night, except when the rains poured like torrents, and by 
these we were often caught when going in the boats either on board, or on shore." 
Afterwards, he observes, (African Memorada, p. 495,) "had we carried out the frame 
and materials necessary for the erection of a large house, it might have been finished, 
in at most one month ; but " as all the timber, which I built with, w ai\ growing at the 
time of our arrival, it was February in the following year, before 1 had a room to put 
my head in. The being exposed during the whole of that time to either the rains or 
the sim must certainly have been a great cause of our mortality." He had before ob- 
served, (African Memoranda, p. 367) that the mortality of the colonists at Bulama, 
"though in some measure certainly to be attributed to the climate, was much more 
to the adventitious circumstances which have been already noticed ; and 1 am inclin- 
ed (adds he) to think that, independent of its having really been the most uvJiealthy 
season of the year, independent of our hard labour, and great exposure during that 
inclement season, much of our very qreat mortality may be attributed, to the uncom- 
mon depression of spints which our situation produced, on the minds of most of our 
colonists; and I verily believe that I should have died too, if I had ever suffered my 
mind to be sosubdqed. But how far this despondency may have contributed to our mor- 
tality, must be left to the decision o? physicians." Upon this passage, Dr. Chisholm 
(at p. 105 of jhis letter) says, "Were I to hazard an opinion, 1 should be inclined to say 
that it contributed as a powerful predisposing cause to the action of infection, which 
had already accumulated in their bodies, like the electric fluid in the Ceyden phial, 
and required only this excitement to destroy at a single discbarge." But surely Dr. 
Chisholm, before he ventured upon this extravagant and most inapplicable compari- 
son, before he assumed tlmexcessive accumulation of some undescribed lebrile contagion, 



■ 

I 









- 



454 

came governor of the colony, (if it may be so called) adopt, in 
smallest degree, any of those measures, for " separating the infected 
from the well," and for "preventing the spreading" of the fei 
which he had at first supposed to be of high importance; and which 
he certainly would not have neglected, with so much humanity and vi- 
gilance as he has manifested on all occasions, had he still retained his 
former opinion. Capt. Beaver was, in truth, so far from believing Dr. 
Chisholnrs allegations respecting the Hankey, that he has, on various 
occasions, given those allegations the most decisive contradiction : 
witness among ethers, the following passage, at p. 305 of his African 
Memoranda, viz. M dily which took place in the island of Bu- 

lama, and on board the Hankey, after her departure from it, was in thi- 
country called the plague, or Bulama fever, b\ those who were inim- 
ical to the success of our enterprise ; and such serious representations 
were made on the subject, as produced an order horn the privy coun- 
cil to sink that ship, though on further inquiry it was not carried into 

should :it least have prove dt!, 
and Hankey or upon i 
has admitted (what might othcrwi 
and during tin- \< 
pieion whatevi r i 
See his Essay on the n 
therefore, that it the \\ ver in 

of theaeships, it must have I arrival on 

guilty ship must have hern the < ' nev 

opinion (adopted to take ad va as coinmu 

mvtittd from her to tht d so 

many facts decisively, proving that filih, crowding, -and all i«ises suppoM 

be* capable of generating febrile contagion, do i '.dor 

temperate climates, and in ciroui ; 'jhfy 

prolific, if they we. e capabh ihall not be here « 

enter upon a particular refill -able 

suppositions, respecting the Calypso and Hank illy as it has been al 

proved that the lii:.;h tempi i I not 

sav to the generation, but i<> I 

pens to be brouglil into that temfmntfitn i' < • umot sid>si*t, mischief 
Dr. Chisholm's u 

PS of vol. I. he asserts, that "tin 
nof seem to admit the generation of a 
letter to Dr. Haygarth 

dies, incontestable proves that heal and filth i 
gerous of all human habitations " Tlie fa< 
trog the different ports of the West India islands before l 

and remarkably healthy." Yet, in the very same letter, he ta Had repeats 

what he had previously declared in his letter to Dr E. H. Smith, thai "a fever (on 
board the Hankey) pn ginallv, perhaps, from theme] die season, 

and the circumstances of the situation of the adventurers, bad 1m 

tilth, consequent impurity of air, and d fexvr, or fever 

of in fiction heightened \n almost .' between the tr%- 

pica .' t .' and a jail fever hci: in an atmos; 

which he had before mentioned a- . high drgrre of 

infection .' /" — And leist these eontradictions 
at p. 217 and CIS of the very same letter to Hat^urth, i 

disease imported by the Hankey to Grenad •iginal Jo~ 

</, and utterly nnknwem before, &e. ( oe 

mane } Had he told us that the sup|>osed causes of this me* 

:?i/<t at Bulama, I should have th - improbable, because these 

animals have been frequently seen on that island, while n< le nor pestilential 

(ever ever was nor as I believe ever will be. 



155 

effect; and the ship was restored to the owners, after their having sus- 
tained very considerable loss, by the industry with which certain inte- 
rested people kept up the report of the malignity of the distemper, 
which it was said that ship brought home, and for which there was 
.not the shadow of a foundation" Again, in a note to p. 192, after 
noticing the report of the pestilential fever or plague, supposed to have 
been carried by the Hankey " from Bulama to Grenada," captain Bea- 
ver adds, "this report was for a considerable time believed; the Han- 
key was sent to Stangate Creek to perform quarantine, and orders were 
given for sinking the ship and cargo ; however, on examination, the 
falsehood and malignity of this report Jbeing proved, this order was 
oonfined to the Bulama baggage only." 

In addition to these facts I shall now adduce the most decisive evi- 
dence, to prove that the fever which prevailed in the Calypso and 
Hankey, and among the ackenturers to Bulama, was the common 
marsh fever of the western coast of Africa; and for this purpose I 
shall first quote the testimony of Lieutenant-Governor Young, who, in 
his " return" of the deaths of the Bulama adventurers, and in allu- 
sion to the fever, which produced so many of them, observes con- 
cerning it, that " the coast fever is of the intermitting kind and not 
infectious" [See Wadstrom, page 313.] This gentleman's com- 
petency to form a judgment on the subject will scarcely be doubted, 
after reading the following character of him by Capt. Beaver, at p. 82 
of African Memoranda : " Young, next to the governor in the council, 
was a man in mind and information inferior to none I have ever had 
the happiness to know. I respected, I loved him : and never was in 
his company without leaving it both wiser and better, from his know- 
ledge and virtues :" and he must have had very sufficient opportuni- 
ties of observing the intermitting nature of til - fever, and its non-in- 
fectious quality, both at Bulama and on \. ;e in the Calypso to 
England, during which about forty of the persons on board are stated 
to have died, mostly of this disorder. Mr. Pfeiba's testimony on this 
subject, as communicated to Dr. E. H. Smith, and* published in the 
New- York Medical Repository, vol. 1, p. 463, is in these words: 
" Concerning the sickness which carried off the colonists, both at Bu- 
lama and Sierre Leone, and on the home passage of the Calypso, it 
may be remarked, once for all, that it was by no means of one kind, 
as the readers of Dr. Chisholm would be led to suppose. Few, if any, 
escaped, altogether, some had regular intermittent lever, (which is 
the fever of the coast,) of various continuance, from a week to seve- 
ral months; others had a violent fever, which terminated favourably 
or r atally, in one, two, three, four, five, or six days ; or which linger- 
ed out after its first violence as many weeks ;* some had diarrhcea. 



* The " violent fever" here mentioned may, in many cases, have been a marsh fever, 
agsp^avcted by some otb^er of the well known causes of fever, sach as being caught by 
heavy rains, drunkenness, fatiguing exercise, or labour in the s in, &c. and in a few it 
may have been produced by these latter causes onlv, though it seems difficult to believe 
thai any person, who had been even but a few works on the island, could hive so far e ; - 
caped the influence of marsh miasms, as that a fever in him should not, in some decree 
have resulted from their influence. 



456 

and dysentery; and others fell martyrs to the indiscreet use of opj; 
and spirits, as preservatives." 

But to render superfluous all other evidence on this subject, I Avilf 
here adduce that of Dr. Winterbottom, who, by appointment of the 
Sierra Leone company, was physician to that colony, when the Calyp- 
so arrived there, with Governor Dalrymple, and the discontentd colo- 
nists from Bulama; and consequently had abundant opportunity of be- 
coming- well acquainted with the fever which prevailed among them, 
and which was supposed to have been communicated from that t 
to the Hankey,} and undoubtedly the testimony of a physician so im- 
partial, and so respectable, by his character, and his general as well 
professional knowledge will be deemed conclusive on this subject It 
was given at p. 16 of the 2d volume of his of the n:> 

Africans, where he says, "the Sever which carried off so many of the 
settlers at Bulama, firei ■ bled .'/;» i 

Sierra Leone, a si which, a Hue opportune 

perhaps be laid before the public ; but -cribed by Dr. 

Chisholm" (meaning the malignant pestilential fever, so called by 
him, and supposed to have been brought by tl ida) 

* ( differs so essentially from that whicl ! at Sierra Leone, that 

it cannot be recog I fterwards, in the 

same page, Dr. Winterbottom com Dv. Chisholm's errors 

in regard to the Mankey, bj • had no communication 

whatever with Sierra i. . u the oth . the t'ah 

alter leaving Bulama, railed for at Sierra Leoni 

she remained about ah ^ hich time upwards 

of the crew and passengers 
attended with any afifxearance of fieculiar mat 
testimony, the unsupported assertions positions of Dr. C 

holm, v. i-.o never was on die coast of Africa, nor personally acquaint- 
ed with any of the facts in question, must be of no value. 

I might h fore, dismiss this part of my discussion, did not 

a regard for truth compel me to notice Capt 1 account of his 

own fever, in order to expose and correct a very important, and si i 
ingly a very culpable, misrepresentation, which Dr. Chisholm has 
made concerning it. This account may be found at p. 161 of his 
African Memoranda in these words : " The letter which I wrote to 
the trustees by the Ilankev was, I think. It 

was written during that and the two preceding days, in those intei 
when I had the full possession of my senses, and was able to apply 
myself for a short time to writing, for long I could not; and each of 
the first two of those days, as well as I 1 before, I was delir 

generally from about 10 A. M.till 2 or 3 P. M. and this was the case in al- 
most all the severe attacks of the fever which I afterwards had. This 
was owing to the excessive heat between those hours; for I invar 
got better as the sun declined, and never experienced the violent 
raging of the fever till the sun had again acquired power on the fol 

| Though the fever was not communicated by one ship to the other, it was o; - 
ly the same in both, and derived .riluvit * 



457 

ing clay." Page 161, African Memoranda. See likewise his othef 
description, at page 173 — 4, and at page 114 — 121 ;* from all which 
his disorder appears to have been one of those marsh, or intermitting 
fevers, the paroxysms of which are often accompanied by delirium, 
at least between the tropics ; and it could not, therefore, possess any 
contagious property, even in Dr. Chisholm's opinion, as delivered in 
various parts of his writings; and particularly in the first volume of his 
Essay, &c. p. 299, in these words, viz. "The true uncombined yellow 
remitting fever, deriving its origin from the miasmata of marshes, 
and the various exhalations from putrid vegetable substances, confined 
humidity, and stagnant water, is not contagious ; nor can it be proved 
to be so in any instance, of Torrid Zone at least" But in direct op- 
position to this opinion, he makes the following unaccountable state- 
ment, at p. 102 of his letter to Dr. Haygarth, viz. " The fever" (at 
Bulama) "appears to have been dinfully contagious ; for in one in- 
stance, particularly, three persons who were near his" (captain Bea- 
ver's) " bed, during his own illness, from which he almost miracu- 
lously recovered, received the infection from his jierson, and died soon 
after" And for proofs in support of this allegation, Dr. Chisholm. 
refers to pages 171 and 172 of the African Memoranda, where indeed, 
mention is made of captain Beaver's illness, and of the deaths of three 
persons in two succeeding days, but without any fact, or circumstance, 
indicative of the existence of any thing like contagion, or of any con- 
nexion between captain Beaver's disorder and the deaths in question. 
The only passages relating to this allegation, which occur in the pages 
referred to by Dr. Chisholm, are the following, viz. 

"Thursday, December 13, 1792. "Very ill; delirious part of the 
day. In the evening, after having somewhat recovered my deranged 
senses, sent for Messrs. Fielder and Hood, the only subscribers able 
to move ; made my will, and gave them advice how to act in case of 
my death." 

" Friday, 14. Died of a fever, and were buried, both Mr. and Mrs. 
Freeman. This couple I married on the 4th of last month. They 
were both taken ill, about ten minutes after the ceremony was per- 
formed, and have been so ever since. They both died this morning, 
within ten minutes of each other, and were both buried in the same 
grave. Myself a great deal better in the morning, but delirious great 
part of the afternoon." 

"Saturday, 15th. Died and was buried this evening. Mr. Fielder. 
This is the man who, two days ago, made my will, and whom I 
thought likely to be my successor. He was young and brave— fit to 

• Capt, Beaver, at p. 354, states himself to hare " had seven separate attacks of the 
fever ;•' a circumstance which even if most of them should he considered merely as re-t 
lapses, must render it very unlike Dr« Chisholm's malignant pestilential fever, which he 
represents as derived from the same source, or contagion, as that which he supposes to 
have produced the fever of Captain Beaver ; for the doctor asserts, that, " by a general 
law of the peculiar contagion" of his pestilential fever, " those once attacked and recov- 
ered are exempted from being aftected by it." See letter to Dr. Haygarth, p. 180. My 
readers will not, I hope, conclude from the mention which I sometimes make of this 
supposed " malignant pestilential fever," that 1 believe such a fever to have ever existed, 
or that the fever so called was any thing else than a modification, or variety, at most, of 
the common non-contagious yellow fever. 

58 



458 

draw a lion's tooth." These being the only deaths to which Dr. Chis- 
Jiolm's reference can be applied, or extended, we must necessarily 
conclude that these were the three persons in his contemplation, when, 
to prove that captain Beaver's fever was dirrfully contagious, he ven- 
tured to assert, that in one particular instance, (leaving us to suppose 
many others probable,) three persons, who had been near captain 
Beaver's bed, Sec. received the infection from his person, and died 
soon after." Now, from the antecedent parts of captain Beaver's 
journal, it appears that the fever, under which he laboured on the 13th 
of December, 1792, had only commenced on the 9th of that month, 
34 days after Mr. and Mrs. Freeman were attacked with that fever 
which occasioned, and lasted until their deaths. It is true, indeed, that 
captain Beaver had been attacked by fever some weeks before, but this 
was not until five days after the illness of Mr. and Mi's. Freeman had 
commenced, i. c. until the 9th of November; and as previous to that 
day, captain Beaver had been well for about six weeks, Dr. Chisholm 
could not, with any degree of truth, pretend that they had received 
febrile infection from his pernon, and died noon after; especially as 
their deaths only happened after forty days ; a protraction of dim 
which I am persuaded Dr. Chisholm has never mentioned, as occur- 
ring in his malignant pestilential fever. 

In regard to Mr. Fielder, no mention is made in the pages referred 
to by Dr. Chisholm; nor, so far as I can recollect, in any other, of the 
disorder which caused his death; nor are we entitled from any thing 
within my knowledge, to conclude that he died of fever. But if this 
did cause his death, it could not have been produced by contagion 
from captain Beaver's person, at the time of making his will; because 
even if his Beaver's) fever had been contagious, we have the strong- 
est reason to believe, that no febrile contagion has ever produced dis- 
ease and death within forty -eight hours from the time of its being re- 
ceived. There is, therefore, nothing which I can discover to excuse, 
and much fes» to justify, Dr. Chisholm in the serious Ubtrty which 
he appears to have taken with the truth, on this interesting subjee 
liberty which is the more extraordinary, because as t! • hich 

have been so strangely misrepresented, were distinctly and perma- 
nently stated in pi i e been no room for any mis- 
take ; and, unfortunately for Dr. Chisholm, the impressions resulting 
from this incident will not be weakened by others, which must hereaf- 
ter fall under our notice. 

Afar this it v. ill be proper for us to return to those 

events which more immediately relate to the crew , f tht Hank* 
whom it has been already mentioned that three v. ere ill of fever, i 
the Calypso sailed on the 19th of July. But 
of the rainy seviscn, they remained compai 
My because they were much less exposed than the settlers to the 
causes of /i . For if the fever had been contagious 

Dr. Chisholm pretends, the seamen, by remaining cctisu: 
with the oold probably have been infected sooner, and in 

greater numb i the colonists who were la' ouring en shore. 

But when the liar i to prepare for her return to Eui 

•her captain, (as is stated in captain F ournal, p. ant- 



459 

Lag ballast, and being unable to procure any of stone, determined t» 
ballast her with wood;" — " all the men he could spare" were sent " on 
shore to cut it;" which is notoriously a most dangerous employment 
between the tropics. It is also mentioned, in captain Beaver's journal, 
under the date of October 31, that " all this day, by permission of cap- 
tain Cox, the Hankey's crew have been stowing away our goods in the 
store-room" on shore. And they are stated toliave been employed in 
this service on the three following days. Again captain Beaver states, 
u 4 th of November.— Four of the sailors came on shore to cut logs for 
»#;** i. e the settlers, — see p. 159. And besides these, they were 
sent upon another dangerous employment, that of watering the ship ; 
by all which they must in that situation have imbibed marsh miasms, 
sufficient to account for their subsequent sickness, aided by other ma- 
nifest causes. After leaving Bulama on the 23d of November, the 
rlankey went to the unwholesome settlement at Bissao, and remained 
there for a week, during which, it may be presumed, that the sailors 
run into their customary irregularities ; and with these, added to the 
other causes of disease, it cannot be thought extraordinary, that " three 
of the crew were taken ill of fever," on the 3d of December, when the 
ship sailed from Bissao. Her getting aground, and the other events 
which followed until she reached St. Jago, have been already men- 
tioned. On this subject, captain Beaver has made the following ob- 
servations, at p. 192 of African Memoranda, viz. — "When the Han- 
key left Bulama, not one of her crew had been buried, although so 
many of the colonists had ; however, a few days afterwards she be- 
came very sickly : and this was most likely increased by the extraor- 
dinary labour, consequent on the ship's running a-ground on the 4th 
of December, in the Bijuga channel ; in which situation she remain- 
ed until the 9th ; and the boat having been sent al>out 90 miles to Bissao 
for assistance, I find noted in the Hankey's Log-Book, on the day of 
her return, which was the 8th, " all the people which came from Bis- 
sao in the pinnace taken ill." lie adds, f this was, in all probability, 
owing to their gvezt fatigue, and exfio&ure to the sun in the day, and 
the dexvs in the night.'* Here it will be observed, that though Dr. 
Chisholm would have us believe that all the sickness and mortality 
which occurred on board the Hankey about this, as well as at other 
times, were produced by that "direful" cont: gi )n, which was ima- 
gined by him, Captain Beaver had entirely discarded all belie f of it, 
and has ascribed events to their usual and natural causes, upon this, 
as well as former occasions. 

I have already mentioned the Hankey's arrival in the Bay of St. 
Francis, at St. Jago, on the 26th of December, whence she removed, 
and came to anchor at Port Praya, in the same island, on the 4th of 
January, 1793; having then lost by deaths, subsequently to her de? 
parture from Bulama, eight of her crew, with live men, three wo- 
men, and two children, colonists, who had been taken on board, I 
believe, all in a sickly condition.* 

* Mr. Paiba states. Hint all the colonists who embarked at Bulama, to return in the 
Hankey, excepting himself, Mrs PaHm, and another woman, Mere un-well ; as might in- 
deed be supposed from preceding events. That " before the Hankey put to sea, all 
the bidding of the sick was thrown overboard, or destroyed ; and the ship was washed 



460 

When the Hankey had been a week at Port Praya, the Charon, 
ship of war, Commodore Dodd, arrived there from England, an event 
which was made the foundation of a most extraordinary misrepresen- 
tation by Dr. Chisholm, in his first publication, respecting what he 
called the "Malignant Pestilential Fever," "from Boullam,** Sec. 
The following is Dr. Chisholm's statement, (p. 87) viz. — 

" With much difficulty they (the Hankey's people,) arrived at St. 
Jago, where they fortunately found the Charon and Scorpion, ships of 
war.* Captain Dodd, of the former, humanely rendered them every 
service in his power; and on leaving them, put two men of each ship 
on board the Hankey. With this aid, they proceeded to the West 
Indies; a voyage to England being impracticable in their wretched 
state. On the third day after leaving St. Jago, the men they procur- 
ed from the ships of war, were seized with the fever, which had car- 
ried off three fourths of those on board the Hankey, at Boullam; and 
having no assistance, two of the four died : the remaining two were 
put on shore here, in the most wretched state possible. Captain Dodd, 
on his arrival at Barbadoes, from the coast of Africa, was ordered by 
Admiral Gardner to convoy the homeward-bound fleet of merchant- 
men. In the execution of his orders, he came to Grenada on the 
27th of May, and hearing of the mischief which the Hankey had 
been the cause of, mentioned that several of the Charon's and Scor- 
pion's people were sent on board the Hankey at St. Jago, to repair 
her rigging, Sec. ; that from this circumstance, and the communica- 
tion which his barge's crew had with that ship, the pestilence was 
brought on board both ships : and that of the Charon's crew thirty 
died ; and of the Scorpion's crew about fifteen. The Hankey arriv- 
ed at the Port of St. George, on the 19th of February, in the most 
distressed situation ; and for a few days lay in the bay, but was after- 
wards brought into the Carenage." 

By the publication of such apparently decisive, though fictitious, in- 
stances and proofs of a most powerful and destructive contagion, on 
board the Hankey, joined to others of equal -value, which were stated 
by Dr. Chisholm to have occurred after her arrival at Grenada, we 
cannot wonder that many persons were so far misled, as to believe in 
the generation and importation of a new and " direfully" contagious 
fever by that ship; for at first the Hankey, and not the Calypso, was 
represented as the parent of this monstrous and dreadful produc- 
tion. Fortunately for the cause of truth, the falsehoods regarding the 
Charon and Scorpion, were detected, and laudably exposed by Dr. 
Trotter, who happened to be then surgeon to the Vengeance, ship of 
the line, one of Admiral Gardner's squadron, under whose protection 

from stem to stern, both above and below, with salt water, and then with vinegar and 
water, and the purification was completed, by thoroughly fumigating her with tar, pitch, 
and gun-powder ; and that this purification was repeated at Bissao ; and he ascribe s the 
eight deaths, which occurred subsequently to the ship's getting a-ground, principally to 
the terror, confusion, great fatigue, &c« occasioned by that event. See New York Medi- 
cal Repository, vol 1, p. 4C6. 

* The Chiron did not arrive until the 1.3th of January, a week after the Hankey's 
arrival : and Scorpion only entered Port Prava on the 34th, one day after the Charou 
had left it. 



461 



the homeward-bound West India summer fleet (of 1793) was then 
ESS! 8 M E , ngla ^ H \ info ™ s -. « p. 327 o the first vo.oht 
« los hi f * 1Ca ' ^ ° n ^.fd of August, a ship, one of the fleet, 
Jhlr, * fT^I V l qUa " ° f Wind ' and recei ^ d other damage 
ow %t P™ m ^ 6 th , 6 S ', gnal f01 ' the V «=ngeance to take he/in 
cZ» Jti P P1 '° Ved t0 be * e Hankev from Grenada and Bulama. 
to as kt 7nT P? ° n T C , ar P enter ? on boa '-d, with the necessary stores 
bJT i. P TF h J ° SSeS A *"* remained for *'-ee or four days, 
ilr^W 7{l - d ' &C ' Dr - Tr ° tter afterwards mentions, how 
fiom this, and other circumstances, he was induced to make inouiries 

concernmgDrChisholm'saccountoftheconsequenceso'LHare's 

Do e cW C °wh. e Z h l h h B C i la, °? and Scor P ion > Particularly from Captain 
Dodd, who « had his broad pendant" in the former ship, and of Mr. 

c™Sf£ T'n WaS her SUI ? eon: fiom «-». »y Dr. Trotter, I have 
copied the following narrauve of their transactions with the Hankey, 



VIZ. 

in 



When the squadron, under Commodore Dodd, came to St. Jago, 
l/9o, the Hankey lay there, in great distress for want of hands 

fr a T S h^ ned tT °,1 e hUndl ? » 5erS ° nS '* men > ™»«>. and ch Wren 
from the ime she had been at Bulama. The fever was now overcome 
Mr. Smithers saw two men who had lately recovered. He prescribed 
to tlte master, who was ill of a venerea/complaint, and for'whlch he 
left h m some mercurials, with directions how to use them; at the 

twTmT If ' ^^ ° f bal ' k - The Charo " a "d Scorpion sent 
K»XZ t T . aSSISt J" nav 'S atin S her to the West Indies. The 
Hankey at this port was cleaned, washed with vinegar, and fumigated. 
Ma fever appeared in either of the men of war in con eouence of this 
communication; they arrived at Grenada in perfect health," fcc. Dr. 
Trotter adds, < It is probable from these facts, that the Hankey did 
not import the infection that produced the Grenada fever.»_It is^also 

t U h! U h' \7 *' e ^f CtS ' eft in the Hanke - V ' could P'-duce the fever, 
lir *? a „; ddll \ was thro , wn awa y, ™d what clothing remained had been 
aired, and probably had scarcely been in contact with the bodv after 
being sick. Mr. Smithers was examined before the (lieutenant) ™- 

Zt n °L°H f " a ^ 0n the the Sub J ect ' and Save his opinion decidedly, 
that the Hankey did not communicate this fever to the colonists." 

r JhSL^? S , tatement ' and other proofs, it has been unquestionably as- 
commnnW ™F Pa« of Dr. ChishoWs account, which assertsV 
communication of any disease from the Hankey to the Charon and 
Scorpion, was a mischievous falsehood, fabricated -without the smallest 

itZeTZ' T ^Y" °, f T Wh; Since the latte r «hip did not lose a 
single man during her whole voyage, and the Charon lost only /oar, 

kev iT^ l by D /- Tr0t,e, '> and whol 'y fore ign ™ the Han^ 
of ti, J ' k, ° ,° f thCSe f ° Ul ' did not belon ? to the Charon, and one 

R„t tw ?S n rK- P."?™ 61 '' Sent t0 En § la nd to be tried for murder. 
aZ7^H " il^Vrf^l" 18 ap0l °gy' whathis "'onement, for having 
t Xut /*,v < A "' these falsehoods? Why, truly, in me preface 
to his second edition, after noticing Dr. Trotter's publication on this 



462 

subject, lie says, p. xxii. " On further iiiquiiy, I find I have been 
correct* in my statement of the circumstances of the interview (an 
interview between ships!) which the Charon had with the Hankey at 
St. Jago ;" and then, as if not willing to retract on the evidence of Com- 
modore Dodd and Mr. Smithers, or without seeming to do it spontane- 
ously from other evidence, (which we are to suppose an anxious regard 
for truth had induced him to procure) he mentions his having been 
" politely favoured" " with the perusal of a Log-book, kept" by " a 
lieutenant of the Charon, during the voyage in question;" in which Ik 
says, " I found that no sickness took place on board that ship in con- 
sequence of the interview." And then he adds, (perhaps as a compli- 
ment to Commodore Dodd and Mr. Smithers,) that " a Log-book is 
unquestionable evidence, and, therefore^ I have S7i/i/iresscd what I have 
advanced on this affair," (a great favour truly! ) t; on the authority 
of the late Mr. Home:'' adding, w but why Mr. Home should men- 
tion this as a fact communicated to him by Ccmmodorc Dodd, I can 
assign no reason:" nor indeed can any other person, as I believe. Bui 
before we employ our time in assigning reasons or motives fur sup- 
posed events, it is always best to inquire whether they have really 
fiened. The question seems to be, — Whether, in truth, Mr. Home 
did inform Dr. Chisholm that Commodore Dodd had told him these 
falsehoods? This being a question of no small importance; the affir- 
mative is not to be assumed with Dr. Chisholm's seeming levity and 
unconcern. For the assumption is nothing less than fixing upon the 
character (as I believe unblemished) of a gentleman now dead, and 
unable to justify himself, the stigma of having invented and propa- 
gated the most groundncss (and in no small degree injurious) E 
hoods ;f for no person will believe that Commodore Dodd, without 
any discaverable motive, should have invented and reported what he 
manifested so much readiness in contradicting, and in authorizing Dr 
Trotter to contradict, and what every man on board the Charon 
Scorpion, as well as himself, knew to be false. 

Had Dr. Chisholm in stating these untruths, named his authority, 
as he ought to have done, and had the person ramed admitted him- 
self to have been the informer, Dr. Chisholm's veracity would not 1 
been impeached, whatever might have been thought of his discrc 
in publishing such reports. But instead of this, he ventured to a 
as from, or, within his oivn knowledge, that Commodore, or Captain 
Dodd, on coming to Grenada, and hearing of the mischief caused by 
the Hankey, had M mentioned'' the falsehoods in question ; and by this 
unqualified assertion, he had made himself re sji onsible for its truth, and 
liable to be considered as its author. I do not mean to decide that 
Mr. Home did not give Dr. Chisholm such information, as he pre- 

* When the principal facts in a statement are true, and the lesser circ-irnstances, c> 
incidents onh, are imperfectly or erroneously stated, the author of such a relation 
describe himself as having been ** incorrect ; ,? but v\ hen all the parte for which a state- 
ment was made, are completely unfounded, aril withoul ixturt of truth, 
other and stronger terms can aioue be proper. [ shovld not hwre msde this observation, 
if Dr. Chisholm had not so often, anil vith very little reaM -and 
most offensive language to others in his wriliugs. 

| Mr. Home, I believe, lost bis life by the bands ; and I will • 

in stabbing bis r.:putatioj;, when lie is no longer able to defer 



463 

tends ; but on a question of this nature, I feci it to be my duty to con- 
sider and weigh probabilities ; and, in doing this, I recollect that Dr. 
Chisholm is, at best, an interested witness, and, therefore, cannot be 
received as one, on this subject; that his own character is in jeo- 
pardy; that when making his groundless statement, he, in a note to 
the very page which contains it, has mentioned Mr. Home, as giving 
him information respecting Captain Coxe's refusal to destroy the ef- 
fects of the Bulama adventurers, unless indemnified ; but has not 
even hinted at Mr. Home as having mentioned the other supposed 
facts, which had just before employed his thoughts and his pen ; 
and which, therefore, it would have been most natural and /iro/ier for 
him to have done, if they really had been stated on that gentleman's 
authority. And I recollect also, that while I have no reason to sus- 
pect Mr. Home of having ever, either wilfully or incautiously propa- 
gated untruths, Dr. Chisholm appears to have done this in but too 
many instances ;* and, therefore, the balance of probabilities, in my 

* Some of these instances have been already mentioned, and others will soon fall un- 
der our notice. But in the mean time, there is one so analo ; ous to the matter in discus- 
sion, that I cannot avoid noticing it h*re, especially as it proves, that instead of hecoming 
more cautious and attentive to facts, as an ato-nemetit for the untruths published respect-, 
ing the Charon and Scorpion ; Dr. Chisholm, subsequently to his 1 etraction of them, did; 
not scruple to assert, and publish others equally void of truth, and for the same mischiev- 
ous purpose of proving his JYevu Pestis to he ilirefully contagioxis. 

The following are his own words, at p. 320, of vol. ii. of his Essay, viz : — ■ When 
visited this island, (St. Thomas's) in November, 179G, an accident furnished me with an 
opportunity of informing myself relative to the history of the malignant pestilential fever 
as it appeared there in 1793,4,5, and at that time. The history was indeed a melancholy, 
but it was also an instructive one An eminent merchant, M. C. G. Fleicker, with whom 
I bad been acquainted at St. Croix, requested mc to visit a valuable young German gentle- 
man of this house, of the name of Schmaler, who bad arrived from Hamburgh only about 
ten days before, and it this time unhappily laboured under a fatal attack of this most 
dreadful malady. In Mr. Fleickers bouse, the malignant pestilential fever had very 
frequently made its appearance during and since 1793, and except in one instance, the 
captain of a Hamburg ship, always fatally. No means, at least none sufficient for tlve era- 
dication of the infection, had been employed on the death of the unfortunate sick, conse- 
quent! y the chambers, which were successively occupied by strangers from Europe, be- 
came a never-failing seminium of the pestilential contagion. A. very fe w days after his 
arrival, Mr. Schmaler felt its inlluence," &c. This misrepresentation, to call it by the 
nii'uKst name, being made known to I. F. Eckard, Esq. Danish vice-consul, at Philadel- 
phia, that gentleman wrote a letter to Dr. Mease of that city, in which after giving a co- 
py of it, he adds the following observations, viz. 

" Dr. Chisholm, no doubt alludes, in the above paragraph to Mr. C. G. Fleieker, who 
resided at St. Thomas's, but who had nor, at the period of Dr. Chisholm's visit any regular 
establishment in the island, but acted as an assistant to my bouse, of which Mr. Schmaler 
was clerk. There being a greatintimacy between Mr- Fleieker and myself, he often in 
my absence, was authorised to superintend my concerns, and this was the case at the time 
M r. Schmaler died. I was, however, at home when he arrived from Europe, and return- 
ed soon after his death. 

" More young men had died in my house, from 1793 to 179G, and even later, than per- 
haps in any other in town ; because more had come out to me from Europe than to oth- 
er merchants. Their deaths, however, could not have been occasioned by the contagion 
remaining in the chambers of the house, as Dr. Chisholm supposes; for the cases took 
place at remote periods, in different houses ; I having changed my dwelling in 1795 — 
Neither could their deaths have been occasioned by the contagion remaining in the bed- 
ding, for the beds and bedding of those who died of a putrid fever in my house -were never 
lined again. Further, according to the best of my recollection, two persons were never ill 
of the fever at any time, in the same chamber, in either of my houses; in both of 
which I had four or five rooms appropriated for clerks: besides many persons slept 
in those chambers without any inconvenience. If Dr. Cbisholm's account were cor- 
rect, my house most have been a lazaretto, for those supposed pestiferptrs cham- 



464 

judgment, is very unfavourable to him. And in any event, a writer 
who will adopt, and give his utmost sanction to unfounded reports, 
when they happen to suit his own purpose, must not expect that even 
his facts, when he happens to state them, will be believed, without 
other authority than his own. 

It will be recollected, that the testimony of Commodore Dodd and 
Mr. Smithers, did not extend to any transactions on board the Han- 
key, subsequently to her leaving St. Jago, and, therefore, a part of 
Dr. Chisholm's statement was left uncontradicted by them, though 
since proved to have been false by the Hankey's Log-book. The part in 
question is as follows, viz : — That " on the third day after leaving St. 
Jago, the men procured from the ships of Mar were seized with the 
fever, which (as he pretends) had carried off three-fourths of those 
on board the Hankey, at Boullam, and having no assistance, two of 
the four died : the remaining two (he adds) were put on shore here, 
(at Grenada) in the most wretched state possible." The object of 
this part of Dr. Chisholm's mis-statement, like that of the former, is 
to prove the existence of this " direful" contagion on board the Han- 
key : but it seems to be as completely destitute of truth as the other. 
The Log-book, indeed, mentions that Samuel Hodge, one of the 
seamen sent from the Charon, on the 23d of January, died on the 4th 
of February ; but Mr. Pabia, a passenger in the Hankey, says this 
man " was unwell when he came on board,"— though " able at that 
time to do duty ;"— " that he grew more and more unwell as they pro- 
ceeded." That " Captain Coxe, who was still unwell when the Han- 
key left St. Jago, recovered his health, before they reached the West 

bers were almost always occupied ; and I can assure him, that commonly a whole 
year, and sometimes a longer period, passed without any one of my family being 
sick of fever. It is, moreover, incorrect, that all those persons died who had been 
sick of the pestilential fever during, and since 1793, except the Hamburgh captain ; 
and also, * that alter the two first years of the introduction of this fever, the inhab- 
itants, without exception, whether Creoles or foreigners, equally suffered.' The 
truth is, that many Europeans and Americans recovered, both before and after the time 
of Dr. Chisholm's visit to St. Thomas's, and the fever never spread to the inhabitants at 
large, but was confined to persons recently arrived from Northern climates, and to those 
on board the vessels in the harbour ; nor was there any apprehension of contagion, ex- 
cept among the shipping I never heard of a single instance of any person who had resi- 
ded for some years in the island being afflicted with the malignant fever. A residence of 
nearly twenty years in the island enables me to speak positively as to thTsiact. 

"I have not the honour of Dr. Chisholm's pei-sonal acquaintance, but as he was so 
polite as to visit Mr. Schmalerin my absence, I feel myself obliged to him, and I am sorry 
I have been under the necessity of correcting his mistateraents. He mentions Mr. Jen- 
nings and Dr. Tucker as his acquaintances at St. Thomas's, and to these gentlemen, as 
well as to Mr. Fleicker, I refer for corroboration of any purt of my statement if re- 
quired. 

Iain, See. 

fSigfied, ) J. F. Eckaiid. 

Philadelphia, Feb. 1, 1S04. 

This letter has now been published seven years, (in the 1st vol. of the 2nd Hexade of 
the New York Medical Repository, (p. 337) of which work Dr. Chisholm appears to be 
an attentive reader,) but he has carefully avoided all notice of it, not pretending (so far as 
I can discover,) to have been misled by even a dead pvsan ; though his letter to Dr. Hay- 
garth must have afforded him a most inviting and suitable opportunity for giving, if it had 
been possible, some satisfactory explanation concerning these his gross misrepresentations 



465 

Indies, (though he afterwards had a return of his disorder,)* and all 
the others were perfectly well, notwithstanding the hard duty they 
had to perform,) and continued so." See New York Medical Re- 
pository, vol. 1, p. 469. 

For these latter untruths, Dr. Chisholm has never, so far as I can 
discover, pretended to have had Mr. Home's, or any other person's 
authority ; and, though Dr. Trotter's publication ought to have con- 
vinced him that they were, at least, very improbable, he confidently 
re -published them as matter of fact, in his second edition ; and has 
not, in any subsequent publication, either retracted, or apologized for 
them, though the truth had been forced upon his notice by the Han- 
key's Log-Book. 

After a passage of 19 days, the Hankey arrived at Barbadoes, and 
there, Mr. Paiba states that, during a great part of two days, her 
captain, passengers, and crew, communicated freely with the inhabi- 
tants, without causing disease in any of them : they did the same af- 
terwards at St. Vincent's; and anchored at Grenada on the 19th of 
February, according to Log-book time, but in ordinary language, in 
the afternoon of the 18th. The next day, several paragraphs appear- 
ed in the St. George's Gazette, mentioning the Hankey's arrival "from 
the island of Bulama, on the coast of Africa;" and " that she and 
another vessel had carried out to that settlement upwards of 300 ad- 
venturers, of whom one-third had not survived her departure from the 
settlement," &c. In addition to these exaggerations, it was asserted, as 
"from good authority, that of the whole number the two ships car- 
ried out, only ten were living when she (the Hankey) took her de- 
parture." 

It is not wonderful that such gross mis-statements should have creat- 
ed apprehensions of danger from supposed contagion in the Hankey, 
among the inhabitants of St. George's, and have also excited and given 
a bias to Dr. Chisholm's industry on this subject. It happened, also, 
that a state of weather then existed, and had existed some weeks be- 
fore, at Grenada, very unlike that of other years, and better suited for 
a copious production of marsh miasmata. This fact appears from an 
account which Dr. Chisholm has himself published, in the introduc- 

* This appeal's to have been an intermittent, of which Captain Coxe is stated to have 
had several returns, as commonly happens to those who have been much exposed to 
marsh miasms Mr. Paiba states distinctly, that while the Hankey was at St. Jago, 
there was no sickness on board of her, but " debility, and slight intermittents ;" that 
" her crew and passengers' mixed without suspicion, and with perfect freedom with the 
inhabitants of Port Praya, and received them on board, where they had a number of en- 
tertainments, of which the governor of the island and several of the principal people 
partook," without so much as a suspicion of any sickness " being excited by it." He adds. 
"Indeed no sickness prevailed at St. Jago during the Hankey's stay, excepting the com- 
mon ague and fever of the place" That during the ten days which the Charon re- 
mained at Port Praya, it was the commodore's " custom to send his barge every morn- 
ing to the Hankey, for Mr. and Mrs. Paiba, who usually spent the day with him, and re- 
turned in the evening. — That Captain Coxe was several times on board the Charon ; 
and both Mr. Smithers and his mate visited the Hankey, and two of the Charon's seamen 
were employed great part of one day about the Hankey's rigging. And finally, that Com- 
modore Dodd had so little apprehension that any person belonging to the Hankey would 
be liable to infect others, that he gave Mr. and Mrs. Paiba a letter of recommendation to 
a gentleman at Grenada ; and in consequence of it, they were invited to reside, and did 
reside at this gentleman's plantation, while they remained on the island. See New- York 
Medical Repcsitorv, vol. p. 468. 470. 

59 



466 

tion to his Essay, of " the changes which took place in each month of 
the years 1784, 1785, 1786, and 1793," and from his " table of the 
highest, lowest, and medium height of the thermometer during that 
time ;" "from all which it results that in 1793, the months of January 
and February were generally rainy, which he notices as " an uncom- 
mon circumstance j and that the heat in those months was uncommon- 
ly great ; the thermometer, at noon, rising to 88, and 89°, and which 
is 3 and 4 degrees higher than it was during the same months in any 
of the preceding years; and seven degrees higher than in 1785. And 
in the three following months there appears to have been such an in- 
termixture, or alternation of showers and of hot sunshine, as com- 
monly renders marsh fevers prevalent in places liable to them. 

Dr. James Clarke, also, in his treatise of the yellow fever, which 
prevailed in the same, and following years, in the neighbouring island 
of Dominica, says, p. 49, " from the month of January to the 15th of 
June, (1793) when this fever first broke out, the weather was extreme- 
ly calm, and much hotter than usual in this and the neighbouring is- 
lands. There was little rain (he adds) till the 15th- of October," at 
which time " this fever became less violent here ; and about the be- 
ginning of November it ceased altogether." In the next page he ob- 
serves, that in June, July, August, and September, Fahrenheit's ther- 
mometer " generally rose to 88° or 90° and sometimes to 92 degrees, 
between the hours of two and four o'clock, P. M." Again, at p. 51, 
he says, " the heat for some months before, and during the continu- 
ance of this fever in the island, especially in the night time, was a/- 
most insufi/iortable." 

Whether the very early appearance of the yellow fever in most of 
the West Indian islands, in 1793, resulted from this unusual state of 
the weather alone, or whether there was a co-operation of other causes 
which were either unknown, or unnoticed, I leave for the considera- 
tion of others and content myself with again expressing my belief, 
that we are not yet acquainted with all the causes which assist either in 
the production of marsh miasmata, or in rendering their morbid influ- 
ence more powerful than usual. But we know particularly from what 
happened at Charleston, in 1732, (see p. 245 and 319,) and at other 
places to be hereafter mentioned, that the occurrence of yellow fever, 
as an epidemic, may be accelerated several months by particular con- 
ditions of the atmosphere : and as Grenada is situated several degrees 
southward of Dominica, and must therefore have sooner felt the in- 
fluence of the sun in its approaches to the northern tropic, we shall 
not be surprized that the fever became prevalent soonest at the former 
of these islands. 

In regard to the supposed communication of febrile, or pestilential 
contagion, from the Flankey, subsequently to her arrival at Grenada, 
Dr. Chisholm asserts, in the first volume of his Essay, (p. 121,) that 
" a Capt. Remington, an intimate acquaintance of Capt. Coxe, was the 
first person who visited the Hankey after her arrival in St. George's 
Bay. This person (says Dr. Chisholm,) went on board of her in the 
evening after she anchored, and remained three days, at the end of 
which time he left St. Georges, and proceeded in a drogher, or coast- 
ing vessel, to Grenville Bay, where his ship, the Adventure, lay. He 



467 

was seized with malignant pestilential fever on the passage ; and the 
violence of the symfitoms increased so rafiidly as on the third day to 
fiut an end to his existence. 1 ' In regard to this transaction, Mr. Paiba 
not only contradicts Dr. Chisholm concerning the time of Capt. Rem- 
ington's visit to the Kankey, (which it seems now difficult to ascertain) 
but he asserts that this Captain " had been all day and night coming 
from Grenville Bay, and had been wet through." " That he slept on 
board in his clothes, and went in an open boat* the next day, back to 
his ship ; enough (adds he,) to kill any one in that climate." See Me- 
dical Repository, vol. i. p. 471. On this point, Dr. Chisholm, in his 
2d edition, (p. 122,) says, "That this person had fatigued himself, and 
had even slept in wet clothes, might have happened ; but does this 
prove any thing further than a greater predisposition of his body to be 
acted on by infection?" Yes, if true, it proves that Capt. Remington 
had been exposed to causes sufficient to produce a mortal fever, with- 
out any infection, as thousands have experienced ; especially in that 
climate. Dr. Chisholm, however, objects to Mr. Paiba's statement, 
because it was made after he had seen Dr. Chisholm's Essay. But 
would the Dr. have us believe that truth is not admissible, if brought 
forward to correct particular misrepresentations? On this subject, 
however, Dr. Chisholm has referred us to "Dr. John Stuart, an emi- 
nent practitioner, who attended him (Remington) at Grenville, when 
he arrived there." And as I have the pleasure of knowing Dr. Stuart 
(who, satisfied with the produce of his estate, has since relinquished 
his profession and title) and entertain great respect for his character, 
as well as the utmost reliance on his candour and veracity, I shall most 
readily admit every thing stated as matter of fact by that gentleman, 
only regretting that his statement on this subject is not more compre- 
hensive. 

It is contained in the New-York Evening Post, of Tuesday, Novem- 
ber 26, 1805, in a letter to Dr. Hosack, to which Dr. Chisholm has 
referred in his printed letter to Dr. Hay garth) and in it Dr. Stuart 
mentions his going, in the month of March, 1793,f on board the ship 
Adventure, then lying in Grenville harbour, to visit the carpenter, who 
was under his care, and then adds, " While there, Captain Remington 
arrived from St. George's by sea : he had come round in a drogher, 
and had had heavy squalls, with rain in his passage to windward. He 
then complained of being feverish, and seemed low spirited ; he had 
heat of skin, his pulse full, and under 100 ; head-ache, pain in his back 

* The droghers, at Grenada, are not properly open boats ; but the space they afford, 
as a protection from ram, under the deck or half deck, is so very close, hot, and confined, 
if my recollection he accurate, that most people rather than avail themselves of it for 
any iength of time, would probably allow- themselves to get wet. 

■j- Unfortunately, Dr. Stuart has not mentioned the day of the month when this hap- 
pened ; but he has mentioned enough to prove, that Dr. Chisholm must have erred con- 
siderably in regard to the time when Capt. liemington went on board the Hankey. Fop 
if it had been, as he asserts, upon the everting- of her arrival at St. George's, this would 
have been on the 18th of February, and supposing him to have remained onboard 3 day*, 
and not one night only, as Mr Paiba asserts, he must, notwithstanding, have set out on 
his return to Grenville Bay, upon the 21st of February, and supposing him to have em- 
ployed two other days in making the passage, though it is commonly done in less than 
one, still he would have reached his ship not in March, as Dr. Stuart mentions him to 
have done, but on the 23d of Febcuary. 



468 

and limbs, and over his whole body. These symptoms I imputed to 
cold caught in his passage up, and accordingly took eight ounces of 
blood from him, which unexpectedly neitner exhibited the buffy coats 
nor the coagulum, any degree of contraction, nor consequent separa- 
tion of serum. He took an emetic of ipecacuanha in the evening, and 
a dose of Glauber's salts the following morning. During three days 
I continued to visit him, his pulse did not exceed 100, nor was the heat 
of skin considerable; he took occasionally small doses of antimonial 
wine, with the addition of laudanum at bed lime, and made free use of 
tepid drinks. At the end of that time, I was under the necessity of 
putting him in charge of a neighbouring practitioner, having a call to 
the other side of the island. On leaving him, I certainly did not en- 
tertain any idea of his being in danger ; I was, however, forcibly struck 
with, and could not well account for, an uncommon degree of despon- 
dency of mind that was then present, and it was not possible to remove 
the impression that he was to die ; nor was I the less surprised, on 
going to Grenville some days after, to be told of his death, and more 
especially to hear of that event having been preceded by haemorrhage 
from his nose, stomach, mouth, and urinary bladder. On this occasion, 
while in conversation with some gentlemen on the fate of this unfortu- 
nate man, I could help noticing the malignancy of the case, and the dif- 
ference in the train of symptoms, from what I had ever witnessed to 
take place in the worst case of our endemic fever. But a few minutes 
had elapsed when a gentleman arrived from St. George's ; I had no 
sooner mentioned Capt. R.'s death to him, and my surprise thereat, 
when he instantly replied, it was none to him, for that Capt. R. had eat 
and slept on board the Hankey, during several days that he was in 
town." 

If my readers will compare this account with that given by Dr. Chis- 
holm, they will, I presume, be forcibly impressed by the important de- 
viations from the truth which occur in the latter, and by the evidence 
which it affords of his inexcusable carelessness about facts which might 
have been so easily ascertained, if he either did not know, and was at 
all solicitous for the truth. It uppears from Dr. Stuart's statement of 
Capt. Remington's case, that, instead of that " violence of the symp- 
toms" and that rapid increase of their violence, which, " on the third 
day, put an end to his existence," as Dr. Chisholm asserts) the symp- 
toms were all so very moderate, that when Dr. Stuart left his patient, at 
the end of three days, he was not even suspected to be in any danger, 
and, according to the best information which I have been able to pro- 
cure, Capt. Remington did not die until the 8th day of his illness.* 

In regard to the cause of Capt. Remington's fever, Dr. Stuart's ac- 
count of it accords, in my judgment, much better with that of Mr. 
Paiba than of Dr. Chisholm. Whether Capt. Remington got wet in 
going to St. George's, or returning thence to Grenville harbour, or 
both, Dr. Stuart avowedly, and with reason, considered his disorder as 
proceeding from cold. And though he appears to have been surprised 

The editor remembers distinctly to have heard Dr. Stuart mention, that it was on 
Sunday that he fii-st pre scr ib e d for captain Remington, that he took leave of him on 
Weunesday ; that his death happened ou the following Sunday. 



469 

at its fatal termination, I cannot persuade myself that it is so unusual 
in that climate for fevers produced by such a cause, to end in death, 
and even with haemorrhage from different parts, as fairly to authorize 
a belief that some more malignant cause must have co-operated ; and, 
perhaps, if Dr. Stuart had never heard of the groundless reports con- 
cerning the Hankey, he might not have suspected any such co-opera- 
tion : though after all that appears to have been told him of that ship, 
his doing so was, I think, very natural. But as my readers will soon 
be convinced, if they are not so already, that no infection was, or could 
have been communicated from the Hankey, and as Capt. Remington's 
fever manifested no contagious property, even in the narrow space of 
a ship's cabin, and when as there was no suspicion of infection, no 
precaution would have been used to guard against it, we have, I think, 
the strongest presumptive, as well as negative evidence, that it did not 
proceed from, or possess any contagious influence. Indeed, if the 
Hankey had abounded in contagion, it must have been altogether in- 
credible that it could have produced disease so speedily ; and if the. 
getting wet, and sleeping in wet clothes should not be deemed a suffi- 
cient cause for the disease and death of Capt. Remington, another, 
and that infinitely more probable, in my opinion, than a new pestilence, 
naturally presents itself to those who recollect, that besides the influ- 
ence of marsh miasmata in the bay and carenage at St. George's, his 
own ship lay in Grenville bay or harbour, which Dr. Chisholm (at p. 
290 of his letter to Dr. Haygarth) has particularly designated as one 
of the places which, in an uncommon degree, expose ships lying 
therein " to the malignant influence of marsh miasmata." 

Dr. Chisholm tells us (Essay, p. 122,) that "the crew of the Defi- 
ance, of Blythe Port, near Newcastle, were the next who suffered by 
visiting this ship ; 'the Hankey ^ the mate, boatswain, and four sailors, 
went on board the day after her arrival ;* the mate remained either on 

* Dr. Chisholm apparently was anxious to lose no time. He made captain Reming- 
ton goon board the Hankey the very evening of her arrival ; though Mr. Paiba says it 
was nearly a month after, which it might have been, consistently with Dr. Stuart's state- 
ment ; and consistently with that statement, he could not have gone on hoard in much 
less than a week : and, therefore, if the people of the Defiance went on board the day 
after the Hankey's arrival, and were immediately seized witli the fever, they, and not 
captain Remington, must have been the first " who suffered." And, as they are snid 
to have all died in three days, excepting the mate, whose disorder was slight, and, there- 
fore of no long duration ; and it is not pretended that any other of the crew took the fever 
from them ; it ought, according to this account, to have ceased entirely on board the De- 
fiance, before the end of February. But by another statement, at p- 202 of the same 
volume, we are told that "about the end of March, 1793, the Herberts, Captain Brown, 
sailed from the Port of St. George, Grenada, for Glasgow. \n working the ship out of 
the harbour, (continues Dr. Chisholm,) Captain Brown was obliged to send five of his 
mc;n on board the Defiance, of Blythe Port, to fasten a warping line. At this time, 
(the end of March) the malignant pestilential fever raged on board the Defiance." It 
always rages in Dr. Chisholms accounts. He adds, " The next day after the Herberts 
sailed, the five men were seized with the disease, and three of them died." Here the 
Doctor's favorite number, three, is applied to the men who died, and not the day or days 
on which the termination happened. Now, what are we to believe amidst these contra- 
dictions ? Did this fever rage on board the Defiance, about the 20th-of February, ac- 
cording to the first statement, or, about the end of March, according to the second ? In 
regard to the latter story, nothing less than Dr. Chisholm's credulity could produce it 
belief If five men were sent in a boat along side the Defiance, w th a warping-line, the 
endol that line might easily have been thrown on board of the Defiance, and fastened 
fey one of her crew, and is often, and as ought to have been done, where a pestilential 



470 

deck, or in the cabin, but the rest went below, and staid all night there. 
All of them were immediately seized with the fever, and died in three 
days." Here Dr. Chisholm seems to have been either totally regard- 
less of truth, or completely infatuated, if he believed this account to be 
true. What,^!^ persons immediately seized with a contagious fever I 
Did any species of contagion ever produce disease immediately ? The 
plague itself does not act with such celerity. Moreover, these five 
persons all died exactly " in three days." Did ever contagion act with 
such deadly and exact uniformity ? Differences of age, constitution, 
susceptibility, &x. were, it seems, completely inefficient. And here I 
cannot help noticing Dr. Chisholm's singular predilection for the exact 
term of three days. The four seamen obtained by the Hankey from 
the ships of war at St. Jago, are stated to have been all seized "on the 
third day" after she sailed, " with the fever," which probably neither 
of them ever had ; and Captain Remington is made to die of it on the 
third day, though Dr. Stuart did not then believe him to be in any 
danger; and again, the five men from the Defiance, are all repre- 
sented as having died in three days, and a sixth, (the mate) as having 
only escaped with a lighter disease, because, by remaining on deck or 
in the cabin, he was " less exposed to the virulence of the infection." 
All this, however, rests upon Dr. Chisholm's unsupported authority, 
the value of which, I must leave others to estimate, having no means, 
except those furnished by Dr. Chisholm, even to ascertain whether 
the ship Defiance ever existed. 

vAfter this, Dr. Chisholm tells us, (p. 123) that " The crew of the 
ship Baillies, from the same imprudent civility, or curiosity, were the 
next who suffered."* " These (he adds) communicated the infec- 

fcver was ragi7ig : and, at most, if this was not done, it could only have been necessary 
for one roan to jump on board, for a single minute. Xo stay could have been allowed, as 
the men must, at that time, have been wanted immediately on board their own ship. To 
suppose, in such circumstances, that they could all have been infected, and that this in* 
fcction should have operated so as to produce disease in them all the very next day, is 
completely inadmissihle, because no contagion yet known, is capable of being transmit- 
ted so far, and in so short a space ; and also of producing disease within 24 hours after 
being transmitted ; and, therefore, if five men helonging to the Herberts, were attacked 
by tlie supposed malignant pestilential fever, they must have previously been exposed 
to the causes which had produced it in others, independently of any communication with 
the Defiance. 

* It is here remarkable, that Dr. Chisholm makes no mention of the nature, or extent 
of the suffering supposed to have been thus brought upon the crew of the Baillies. He 
might have told us, at least, how many had been attacked by the supposed mrw fever, on 
board that ship ; and I certainly regret that he did not. He gives us, indeed, four sup- 
posed cases of that fever, which fell under the management of his partner, Mr. Camp- 
bell, at a time when Dr. Chisholm himself was under salivation for hepatitis, and proba- 
bly before he had seen any case of this fe\^r. One of these without date, but said to have 
been the first which occurred in Mr. Campbell's practice, was that of the carpenter of 
the ship Charlotte, of London, which is not mentioned by Dr. Chisholm as having had 
any communication with the Hankey : and the second is the case of "John," a sailor on 
board the Baillies. And this was probably the first case of fever which occurred on 
board that ship; for, as the partnership of Chisholm and Campbell appears to have had 
her sick, it is not likely that any other practitioner was employed. Mr. Campbell first 
saw John on the 2lst of March, 1793, on which day he first resolved to make trial of 
mercury, and this in John's fever ; being, as he says, "fully satisfied that this disease was 
the malignant fever, which prevailed at that time." Now, if Dr. Chisholm's account ot 
the commencement of this fever was correct, how could the malignant fever be then 
prevalent F Captain Kemiugton had sickened some time in March, and for any thing 



471 

tion to the ships nearest to them, and it gradually spread from those 
nearest the mouth of the Carenage,' where the Hankey for some time 
lay, to those at the bottom of it ; not one escaping, in succession, what- 
ever means the captain took to prevent it." An effect which, if cor- 
rectly stated, is much more like that of marsh miasms than of contagion. 
This statement, however, is too general for a particular examina- 
tion, and being, like the former, without any support, I can have no 
reliance on its accuracy. That a violent marsh or yellow fever did at 
that time, or soon after, prevail among the shipping at the Carenage, 
at Grenada, ( as it had often done there, and in the like situations, long 
before the supposed generation of Dr. Chisholm's new pestilence,) I 
believe ; and I also believe, that this fever (which, as usual, began 
among the seamen) soon after appeared in some of the inhabitants on 
shore, but not as Dr. Chisholm supposes from contagion. We have 
seen that the Calypso, who is supposed by Dr. Chisholm, to have in* 
ftcted the Hankey, and whose fever consequently must have been 
the same, was not suspected at Sierra Leone to have communicated 
any disease there, nor to have had any other than a marsh fever on 
board. And we have seen that she returned thence to England, after 
suffering a mortality, greater in proportion to her stay in Africa, than 
that of the Hankey ; and it never was even suspected, that either her 
crew, or her surviving passengers, with all their bedding and effects, 
and those of the dead also, (though landed and dispersed in Great 
Britain) had introduced any sort of contagion, there being fortunately 
no person here, to excite groundless alarms, by inventing and propa- 
gating falsehoods as in Grenada. In regard to the Hankey, we have 
every reason to believe that no other than marsh fevers, or fevers from 
cold, fatigue, intemperance, and other similar causes, and had occur- 
red on board of her during the whole voyage. It appeal's, moreover, 

that appears to the contrary, subsequently to John „• and also at a remote part of the 
islund. The Baillies is stated by Dr. Chisholm to have been the second ship which com- 
municated and suffered by communication with the Hankey ; and, from his second state- 
ment, quoted in the preceding note, she appears to have been the first. But supposing 
the Defiance to have been the first, the sickening of a part of her crew alone, could not 
justify Mr. Campbell in stating this to have been a prevalent fever, nor that it was one 
in which he was "well convinced the common mode of practice Mas by no means success- 
ful." To have acquired this conviction, he ought to have had a considerable number of 
eases, or have known that many cases of this new disease had occurred to others, and 
terminated unfavourably under "the common mode of practice in fever." But such 
eases could not have happened, according to Dr. Chisholm's statement, from a commu- 
nication with the Hankey ; and it therefore seems probable, that what Mr. Paiba has 
asserted in the New-York Medical Repository, vol. 1, p 47, may be true, viz that this 
"sickness was universally known to be in the town of St. George, when captain Bern- 
ington visited the ship," the Hackney. And Mr. Campbell's first case, that of the 
earpenter of U»e Charlotte, before mentioned, seems to prove that at least in this in- 
stance, the supposed new fever was not derived from the Hankey. Mr. Campbell men- 
tions a second case on board the Charlotte, that of Mr. Taylor, the mate, but without 
any date ; and he also mentions a second case on board the Baillies, that of "Stephen, 7 * 
which occurred on the 10th of April : and these are the only ones mentioned to have oc- 
curred on board that ship, either by Mr. Campbell or Dr. Chisholm. It seems remark- 
able, also, that Mr. Campbell does not even hint so much as a suspicion, that either of his 
patients had communicated with, or derived his fever from the Hankey ; and to me it 
seems probable, that cases of this supposed new fever had appeared at St. George's before 
the Hankey, though not much noticed, as indeed they were not likely to be, while spam- 
die, and few in number. 



472 

that she was three times cleansed and fumigated, viz. at Bulama, Bis- 
sao, and St. Jago; and at the, latter of these places, (at least) she 
must have been free from any contagion; for otherwise, her un- 
restrained intercourse with the inhabitants, would have excited disease 
in some of them ; which it did not, nor in any person on board the 
Charon or Scorpion, nor in the four sailors obtained from those ships 
by Captain Coxe; who, during the subsequent part of the voyage, 
could not have escaped it, if any had existed, capable of producing 
fcuch wonderful effects as Dr. Chisholm has supposed, in Grenada. 
It appears certain, that every body on board the Hankey was well, 
when she arrived at Grenada, and continued so during her stay there, 
and also during the whole of her voyage to England, which is proba- 
bly more than could be said of any other ship then at Grenada ; so that 
even if it were ascertained that an importation of febrile infection had 
then taken place, every other ship ought to have been suspected of it 
before the Hankey, coming, as she did, from a place where there is 
good reason to believe no contagious fever had ever existed. Dr. 
Chisholm, indeed, does not pretend that the infection supposed to 
have been derived from the Hankey, had emanated from any person 
actually on board when she arrived at Grenada, but from the baggage 
and effects of the deceased colonists : to this, however, there are in- 
superable objections, some of which will be stated in the subjoined 
note ;* besides others, arising from the fact of its having been found 



• It appeal's from Mr. Souther's account, that the baggage and effects in question 
consisted of clothing, which " had been aired,"' and probably never in 4> contact with the 
body of any person," after that person became " sick ;*' though as there was no conta- 
gious sickness among the colonists, that circumstance seems to be of but little impor- 
tance. 

In regard to the bedding, Mr Smithers confirms Mr Paiba's assertion, that it was 
thrown away at Bulama. But whatever the effects bmught from Bulama may have 
been, they were carefully preserved by Captain Coxe, and *' delivered up" at Sti.ngate 
Creek, on the ISth of October, 1793, as is proved by the Hankey 's Log Book, (though 
Dr Chisholm has asserted, without any foundation, that they were thrown overboard at 
Grenville Bay ;) and therefore, it w ill be easy for me to place Dr. Chisholm in a most 
embarrassing dilemma. Assuming, as he does, that the Bulama baggage was the ve- 
hicle, receptacle, or fomites, whence tiie Hankey "s supposed contagion issued, he must 
necessarily coi elude, either that this contagion was most powerful at first, and that it dai- 
ly became weaker ant! weaker, by constant evaporation, and diffusion through the atmos- 
phere; or, he must conclude, according to the common opinion in regard to fomites, that, 
like vermin, it possessed the power of multiplying itself, and of becoming daily more pow- 
erful aud destructive. Should he adopt the first of these conclusions, it will be necessa- 
ry, though impossible, for him to explain how this baggage could retain enough of conta- 
gion, to produce such wonderful and unexampled effets at Grenada, though when in its 
stronger and more accumulated state, it was too weak to excite disease in Mr Smithers 
or his mate, or any other person at St. Jago, or in any oi the seamen during the pan 
thence ; and if he should prefer the latter conclusion, it will be equally necessary, and 
equally impossible for him to explain, why, if this supposed contagion had become 
and powerful, as is pretended, at Grenada, it should, with its power of farther multip 
and increasing itself, have been found perfectly inert, and harmless, during the passage *.o 
England from Grenada, not only to the six seamen received by Captain Coxe from the com- 
modore a t thalisland, (onthc 18th of July, )butnlscto the carpenters sent on board the Han- 
key, from the Vengeance ship oi war, (on the '2-d of August.) and who remained thr< 
i'our days on board ? The contagion, by this time, ought ot rtainlj to have become '•</. 
ft/" active; and the carpenters, as well as the six seamen Inly mentioned, must have bv-en 
much more exposed to it, and for a much longer time, thar any of those, who according 
to Pr. Chisholm, so suddenly became its victims at Grenada. Aud, on either supposition 



473 

that such effects are absolutely incapable of exciting Dr. Chisholm's 
supposed malignant (or any other) fever, after having been used by 
hundreds ill, and dead of it. H^, as is well known, and his adher- 
ents at Philadelphia, insist most strongly, that the yellow fever which 
prevailed as an epidemic in that city, in 1793, had been imported 
from the West Indies, and that it was truly the malignant pestilential 
fever, supposed to have been derived from the Hankey ; and it is 
solely upon this identity, that they found their assertions and belief of 
its being contagious. It is also known, that during the prevalence of 
this fever in that year, an hospital was opened at Bush-Hill, near Phila- 
delphia, and appropriated exclusively to the reception of patients ill of 
it ; who, in great numbers, were placed under the care of M. Deveze, 
as was mentioned by me, at p, 258. And it is also well known, that 
when the fever had ceased, as usual, at the approach of winter, all the 
bedding, blankets, clothes, and other effects, which had been used 
by the sick, were sold to the Agents of the French government, and 
employed for their sick soldiers and seamen, without having been 
washed, fumigated, or even aired, and without its having been e ver 
suspected that any disease was produced by these effects. See Dr. 
Valentin's Traite de la Fievre Jaime, &c. p. 92 and 93.* 

Those who are acquainted with the town and neighbourhood of St. 
George, in Grenada, will readily believe, that it is much more likely 

it h incumbent on him to shew how, with this amazing; activity at Grenada, Mr. Paiba and 
his family were able to land there, with all their effects, including a quantity, of goods, which 
with the Bulama baggage, made the whole of the Hankey 's lading;, and which we.e stored 
at the house of Mr* Napier, in St George's, without even the suspicion of having infected 
any person ? 

To account for the wonderful escape of Mr. and Mrs. Paiba and their servant, from 
that supposed infection, which is said to have rendered the slightest communication with 
the Hankey so deadly to others, D .-. Chisholm asks, vol, 1, p. 131, "What connexion 
had Mr. Paiba and his famiiy with the packages of clothes and bedding, from which em- 
anated the infectious aura, productive of almost" (he might have omitted the almost,) 
"unexampled mischief ?" To this inapt question, J answer, that their connexion, during 
nearly three months, which thev lived on board the Hankey, after her departure from 
Bulama, must undoubtedly have been much greater with the packages in question, than 
Captain Remington's or any of the seamen, whom curiosity or civility brought for a 
short time from other ships, and who may be presumed never to have even -seen them ; 
and, it is difficult to conceive, how those packages, even if they had been infected, could 
have done tiie mischief supposed. It is not pretended that they were opened, or even 
removed by Captain Cove ; who, faithful to his trust, and convinced of their innocency t 
had determined to carry them to England, and could, therefore, have mo motive to open 
or shew them to any one. In short, there never was, in my opinion, a more inconsistent, 
improbable, and incredible talc, imagined, than this, which is, I believe, now sufficiently 
refuted. 

* The following are Dr. Valentin's words, viz : — " Le vetemens, les fourniturc s des 
Jits, qui avaient servi a des personnes infeetees, oa mortes de la fievre jaune, et qui oat 
passe a d'autres, sans avoir meme ete acres, laves, on parfumes, ne la leur ont pas trans- 
mise. On en a eu un exemple frappan*, dans les fournitures qui ont ete vemlus, tic; 1 hos- 
pital de Bush-Hill, immediatement apies Fepideinie des 179&, par !e coraite de Saute tie 
Philadelphie, aux Agens de la Kepubliqc Frangaise, pour les militaires aaalades comme 
\\\ rapporte mon ami Deveze auquel ils ont etc conjies.'''' Indeed, thousands of proofs 
might be adduced of the innocency of clothing, &c. after having been used in North 
America, by persons labouring; under that very fever, which Dr. Chisholm supposes to 
have been imported to Grenada by the Hankey, and afterwards transported to different 
parts of the Continent, Spain, Sec. And, therefore, all his assertions of the emanation 
of contagion from the Bulama baggage, must be unworthy of a moment's consider** 
tion. 

60 



474 

to produce violent marsh or yellow fevers, than Bulama, where the 
greatest heat felt by the colonists, appears not to have exceeded 84 de- 
grees ; and nothing but the aggravated and fallacious reports spread 
upon the Hankey's arrival, could ever have suggested the idea of 
looking to the latter of these islands as the source of what Dr. Chis- 
holm mistook for a new pestilence. Dr. Lind mentions, at p. 180 of 
his work on the Diseases of Hot Climates, that a " malignant sick- 
ness in the islands of Grenada and the Grenadines, proved very fatal 
to the English, who, upon the peace, in 1763, first went over to settle 
there." In a work, printed at Paris, in 1805, under the title of Obser- 
vations sur la Fievre Jaune, Sec. par J. B. Le Blond, Medicin Natu- 
raliste, Sec. (who formerly practised physic in Grenada,) the author 
mentions the yellow fever as having occurred frequently at that island, 
and with great mortality to strangers ; adding, that " its malignity was 
shocking, in consequence of the unhealthy exhalations from the/; or' 
and town of St. George. (Sec Medical Repository, vol. 10, p. 78.) 
And Dr. John Hunter, at p. 307 of his work on the Diseases of the 
Army, says, "The town of St. £eorge lies low, and there is marshy 
groi urhood ; the troops, in such situations, have al- 

ways be Khy," Sec. These accounts are, however, too gene- 

ral ; and therefore, I will add, from my own recollection, that this town 
is situated at the foot of a steep and lofty hill; (Mount Cardigan) and 
on both sides of a ridge descending from its summit towards, and into 
the sea, and forming what is called the Carenage, or harbour, at the 
"bottom of a capacious bay. This Carenagc is a long inlet or arm of 
the sea, in winch vessels are land-locked, (except a small opening at 
the south-west, whence the wind rarely, if ever blows,) and are moored 
close to the wharfs ; and here, both the atmosphere and water are com- 
monly stagnant, in a considerable degree: the shore on this side of the 
ridge or town, is remarkably low, and crowded with houses and other 
buildings, reaching close to the wharfs; most of them small, built of 
wood, and filled with low and profligate inhabitants. And in addition 
to all these circumstances, obviously favourable to the production of 
yellow fever, there is a large offensive marsh at the east end of the 
Carenage, over which marsh, the wind commonly blew upon this 
inlet, and ■he greatest part of the town, during the months in which 
the supposed new fever became prevalent. But I would not have it 
understood, that those only were attacked with the fever who lived 
within the reach of marsh miasms. Mankind exercise their locomo- 
tive powers; and when these miasms are not brought to their habita- 
tions, they often go on business, or pleasure, to situations in which this 
cause of disease abounds. In this way, persons commonly residing 
or stationed on Richmond Hill, and Mount Cardigan, were sometimes 
attacked by the fever, though much less frequently, and with less vio- 
lence, than others. Dr. Chisholm considered these attacks as the. ef- 
fect and proof of contagion; but the late Dr. J. Hunter had, nearly ten' 
years before, thought more justly on mis subject; for, at the page 
lately emoted, after mentioning the salubrity of these elevations, he ad- 
ded, " But in order that troops may enjoy the full benefit of such situa- 
tions, care should be taken that they be not permitted to go dow 
the low grou:ids, for if they are, they will infallibly carry fevc 



4>1S 

with them." Dr. Lind had, indeed, previously convinced himself of 
this truth ; for, at p. 2 17 of his work on the Diseases of Hot Climates, 
he observes, " that in several places, mentioned as a secure refuge 
from sickness," (by marsh effluvia,) " there are instances of persons 
being- seized with the diseases of the adjacent country. The yellow fe- 
ver has been known to seize persons in the garrison of Monk's Hill, 
in Antigua ! But inferences (he adds) drawn from a few uncommon 
cases, have no force against observation and experience." — " unless 
the garrison of Monk's Hill had been apprised of the danger of sleep- 
ing in unwholesome places, and had cautiously avoided sleeping out of 
the garrison, the question cannot be fully determined, whether persons 
who never slept out of Monk's Hill, were attacked with the diseases 
of the adjacent country ? It is my opinion, they seldom or never would. 

"I mentioned the affair to a person who had resided long at English 
Harbour, in Antigua, and he informed me, that he had known some 
of the garrison on Monk's Hill to have had the yellow fever. I de- 
sired he would endeavour to recollect the circumstances of their being 
taken ill, and whether they had slept any nights preceding their illness 
in the low grounds, or in English Harbour. It immediately occurred 
to him, that when he was seized with the yellow fever, there were at 
the same time, two officers belonging to the garrison at Monk's Hill, 
labouring under it, who had both been seized with it early in a morning, 
after sleeping the two preceding nights at English Harbour. Upon 
beginning to cons der the great danger of sleeping in unhealthy places, 
(with which he was before entirely unacquainted,) he recollected that- 
most of the people in Monk's Hill, who had been seized with this fe- 
ver, were taken ill after sleeping on the low grounds; it being a com- 
mon custom among the officers of that garrison, to sleep in the house 
at English Harbour where they had dined and supped." I need 
hardly mention that English Harbour notoriously abounds in marsh 
miasmata. The application of these facts will be obvious. 

Dr. Chisholm has laboured, as the foundation of his whole super* 
structure, to create an essential difference between his supposed new 
fever or pestilence, and the yellow fever, which had previously exist- 
ed in the West Indies and North America ; and for this purpose has 
employed the most strained, though unavailing efforts to identify it 
with the true plague ; and he concludes a chapter on this subject by 
declaring, (vol. 1, p. 322,) that "We must consider the fever of 
Grenada, in the years 1793, 1794, and 1795, as truly pestilential, 
and differing from the plague, strictly so called, only in not always 
exhibiting those symptoms that are said to be peculiar to that malady." 
Surely, when Dr. Chisholm committed himself so unfortunately, he 
could not have recollected that the plague had never existed between 
the tropics. My readers, I presume, will not expect that I should em- 
plov their time, or my own, so unprofitably as I must do, if I were se- 
riously to refate a conclusion so extravagant, after the facts recently 
:1 in my chapter on the plague. Indeed, Dr. Chisholm has not 
eared to be satisfied with his own opinion on this subject, for, 
without disclaiming, he has strangely deviated from it in several in- 
stances; sometimes representing his supposed new malignant fever, 
as resulting from " the united ae'ion of ftegfilcntlal eontcgion, and the 



476 

miasmata of marshes, and other direct causes of the yellow remitting 
fever," Sec. See vol. i, p. 208. And at other times, after laying aside 
his pestilential contagion, he substitutes that of typhus or jail fever, and 
represents this as having caused not only his supposed new fever at 
Grenada, and in other parts of America, but also that typhus which 
prevailed among the troops under General White, at Cork,* and af- 
terwards in the passage thence to Barbadoes, in 1796, as I have men- 
tioned at p. 344 ; thus deriving fi*om one cause, two fevers, as diffe- 
rent from each other as any within my knowledge. Dr. Chisholm 
seems, however, as little disposed to adhere to his jail infection, as to 
that of the true plague; for, in his letter to Dr. Haygarth, which is 
the most recent publication of his sentiments on this subject, we find 
these words, at pages 117, 118, viz : — 

" To conclude, let the unbiassed reader now become umpire, and 
decide whether, or not, a l nova pestis, a peculiar, original, foreign 
'•pestilence, recently generated, and utterly unknown before, endued 
'with a new and distinct chancier, possessing new powers of devas- 
4 tation, and capable of propagating itself by contagion throughout 
l the world,' was introduced by the Hankey, on the 19th of February, 
1793, into Grenada." He adds, " The demonstration of my senses, 
and the clearest perception of my mind, assure me it was a nova pes- 
tis, to which the observation of Thucydides is truly applicable ; for 
never before had so r readful a pesdlence occurred in the West Indies, 
nor such a destruction of the human race been recorded." 

Here it is remarkable, that though Dr. Chisholm declares the Gre- 
nada fever of 1793, to have been a new, peculiar, original pestilence, 
never known until the 19th of February, 1693 ; yet in the very next 
page, he makes it a very old disease, by asserting, that if it be compar- 
ed with the plague of Athens, as described by Thucydides, " we shall 
find that they bear a strict affinity to each other, in their causes and 
symptoms ;" and that " they seem, indeed, to have been the same 
disease, the same destructive monster." But though Dr. Chisholm 
excites our astonishment, and tries the extent of our credulity, by his 
accounts ; — first of the miraculous creation of a new and terrible pes- 
tilence ; and then of the almost as miraculous revival of one, which 
had been for many ages extinct, or unknown, he has kindly relieved 
us from these awful impressions, by stating in a letter to Dr. David- 
son, dated Demerary. August 10, 1800, that a fever then prevailed in 
that colony, whose u features were almost without exception, precisely 
those of the malignant pestilential fever of Grenada, of 1793 and 
1794;" — " fully as fatal, as rapid* and as insidious ;" and that this 
direful fever originated in a ship, which had u arrived about t! 
ginning of July, or end of June, from Liverpool, after touch 
Surinam." — " The filth on board, (he adds occasioned by a ear 
horses, and the extreme neglect of the officers and crew, beggars all 
description " (See Medical Repository, vol. 5, p. 229. Here we 
have Dr. Cbisholm's new pestilence, script by his own hand of every 
thing miraculous and wonderful, with which he had previously cloth- 
ed it, as proceeding from Africa and the Hankey ; and we a: 

• See Dr. Chisholm's Essay, &c voL 1, p. -203, et st«j. 



477 

'.hat it -was produced by a common vessel, making a common passage 
from Liverpool to the West Indies, and with nothing more extraordi- 
nary than a cargo of horses ; of which, thousands of cargoes have at 
different times, been brought to the West Indies, particularly from 
New England, as" closely stowed at least, and probably with sailors as 
neglectful, as those of the Liverpool ship, and all, as I believe, without 
any suspicion of having ever generated a contagious fever. Indeed, the 
only peculiarities which belong to a ship with horses, are those which 
occur in stables on shore, and which are not found or supposed to pro- 
duce any morbid effect, much less to have ever generated any species 
of pestilence, or pestilential fever. Dr. Chisholm mentions in the 
same letter, that at the request of Drs. Dun kin and Lloyd, in Sta- 
broek, and of Dr. Ord, on the Eastern Coast of Demerary, he had 
visited a few of the sick with this fever, and that he had " no hesita- 
tion in pronouncing it a fever of infection" No person will, I be- 
lieve, suspect Dr. Chisholm of any great disposition to hesitate in 
pronouncing ; though I have good reason to believe that the gentle- 
men whom he mentions .as having called for his intervention, did hesi- 
tate ;* and that they were very far from adopting the decision pro- 
nounced so readily; having been long acquainted with the first of 
them, and having had opportunities of conversing with him on this to- 
pic, several years after the date of Dr. Chisholm's letter. But I am 
entering unnecessarily into a refutation of Dr. Chisholm's inconsistent, 
extravagant, and incredible notions, which only need to be stated, and 
contrasted, in order to their being properly estimated. 

Here, then, I might have desisted from any farther observations on 
this subject, if Dr. Chisholm's supposition of novelty in the fever of 
1793, at Grenada, had not been countenanced, and in a great degree 
adopted, by Dr. Stuart, whose opinions I consider as justly intitled to 
a respectful attention. This gentleman, in his letter to Dr. Hosack, 
lately mentioned, has stated his reasons for believing, that the fever in 
question " was specifically distinct from every form of tl?e indigenous 
bilious remittent," which he had ever before observed. These reasons 
are, — 

1st. — " Because it appeared at a season of the year which I had al- 
ways found healthy, during 19 years I had resided in the colony." But 
this, as I have already observed, can decide nothing. The occurrence 
of yellow fever, principally depends upon the temperature, and other 
conditions of the atmosphere, and if these conditions take place before 
the usual time, (as was the case, according to Dr. Chisholm's state- 
ment, in 1793,) the fever will be also precocious. It has been already 
mentioned, particularly at p. 2 45, that the yellow fever, which rarely 

• In the month of February, 1805, the editor passed two nights as the truest ot Dr. 
or Mr. ()i<), (former!} surgeon to the 39th regiment,) when going from Demerary tm 
Berbice, and returning thence ; and was, each time, distinctly told by him, that he had 

never seen any fever in that colony, or on that coast, whichThe believed to have been 
cwttag-ioiis. The editor has also heard a similar opinion from Mr. Dunkin, lately Gar- 
rison Surgeon at Demerary, and now Deputv- Inspector of Army Hospitals, when con- 
versing with him on this subject Indeed this gentleman's very accurate and judicious 
report, concerning the prevailing fevers of Demerary, (see Chisholm's Kssay, See. vo. 
2nd. j; 203. &e.) shews, that his ideas and reasonings were too well founded for him 
to have ever adopted opinions like those of Dr. Chisholm, in regard to the existence of 
contagions fever, in that part of America. 



478 

prevails at Charleston before the month of August, became very ge- 
neral and mortal there, in the month of May, 1732. A like precocity 
happened at La Vera Cruz, in 1802, when, according to a statement 
by the " Consulado" of that place, a mortal sickness, with a black vomit- 
ing, began there in April, and raged with extraordinary violence until 
October, causing the deaths of fifteen hundred seamen, and strangers 
from the interior and higher country. See Medical Repositorv, vol. 
10, p. 296. 

2ndly. — " Because it did not particularly appear in those situations, 
where bilious remitting fever usually prevailed, during the unhealthy 
season of the yea]-." This being a general statement, I can only an- 
swer it generally, by reminding my readers of what has been already 
noticed, in different places, that the most violent forms of marsh fever, 
accompanied with black vomit, &c. commonly require for their pro- 
duction, the co-operation of all, or some of the circumstances or pecu- 
liarities of a large sea port, or commercial town, accessible to ships or 
vessels. And, therefore, yellow fever, strictly so called, often does not 
appear in some marshy situations, which are very iiable to bilious re- 
mittents. 

Srdly. — " Because there was an evident difference in the character 
and type of the two diseases ; there was a greater despondency of mind 
in this fever; the eyes were more muddy and inflamed, there was com- 
monly a deep-seated pain in the eye sockets, the motion of the eye balls 
was attended with uneasiness; the pain in the back and limbs was 
greater than in the bilious fever; the vomiting was not of so violent 
and straining a nature, nor was there such evacuations of bilious mat- 
ter.* The black vomit generally occurred at an early period; the 
yellowness was of a dingy hue,- not of the real icteric tinge, accom- 
panying cases of bilious fever. The delirium was, in many instances, 
of a peculiar nature, and much resembling a state of intoxication ; hae- 
morrhage was more tVequent, particularly by urine, and from the sto- 
mach and intestine 

This statement, in my apprehension, relates chiefly to the plus vet 
minus of particular symptoms, and presents nothing new, or characte- 
ristic of a new disease : nothing, at least, of any importance, which had. 
not been noticed and described by Towne, Warren, Lining, Moultrie, 
Hume, Hillary, Mosely, and others, as occurring in the yellow fever, 
long before the year 1793. Indeed, the differences here alleged, as 
distinguishing the supposed new fever, seem to depend solely upon an 
increased violence, or aggravation in the usual symptoms; and, there- 
fore, never could, according to my conceptions, alter the nature or kind 
of a disease, or create even a new species of it. 

I have already, in various places, adduced numerous, as well as high 
authorities, to prove mat marsh fevers are liable to all the variations 
noticed by Dr. Stuart, and therefore I cannot persuade myself that they 
afford any ground for considering the fever of 1793 as a new disease. 
Perhaps Dr. Stuart had not sufficiently attended to this fact. He men- 

* Dr. Chisholm asserts, vol 1, p. 17 i, that " the vomiting was, for the most part, por- 
raceous ; but towards the fatal crisis, always black, aud resembling coffee badly boiled-' 
Jt may be hoped, that he does not consider this as a new symptom, or as the mark of n 
new disease. 



479 ' 

lions, in his letter to Dr. Hosack, that he had for nineteen years exer- 
cised his profession at a considerable distance from St. George's, and 
that his ordinary residence during that time was four miles from even 
the small fiort of Grenville ; consequently his patients must have been 
in a great degree separated from those circumstances, or causes, which 
have been mentioned as modifying and aggravating marsh fevers, into 
that particular form which is called yellow fever; and as this fever had 
not for many years prevailed with so much violence and exasperation, 
even in the large sea-jiort towns of the West Indies as it did in 1793, 
Dr. Stuart might well have been strongly impressed by this aggrava- 
tion of its symptoms, beyond any tiling which he was accustomed to 
see ; and believing as he did the extravagant reports which were cir- 
culated respecting the Hankey, he might naturally have been persuaded 
that the fever in question was a new disease. 

This fever, at Grenada, appears in most cases, and especially those 
of seamen, (who were the greatest sufferers by it) to have resembled 
that variety or modification of the disease, to which the French applied 
the name of Mai de Siam, more than a century ago; and in which 
from a scorbutic taint (as I have supposed, at p. 237) or some other 
cause, haemorrhages, black vomitings, and petechiae, were predomi- 
nant symptoms; occasioned, undoubtedly, by what has been called a 
dissolved state of the blood ; which seems to occur (at least in some 
degree) before death, in all the more violent forms of yellow fever. 
And, by attending to this fact, we shall find no difficulty in accounting 
for the early appearance of black -vomiting, in the fever of 1793, as 
mentioned by Dr. Stuart, nor for the dingy hue which, from extrava- 
sations of blood, was given to the u icteric tinge" of the skin; nor for 
the more frequent occurrence of haemorrhage from the urinary blad- 
der, stomach, and intestines. Nor can we be at any loss in explaining 
why the stomach, in that gangrenous state, which frequently attends 
the worst cases of the disease, should be less irritable, and less capable 
of violent strainings to vomit, than it is when less injured, as in the or- 
dinary bilious fever; nor why the least violent strainings should pro- 
duce the smallest ejections of bile ; nor why exudations of blood into 
that viscus, should change the colour of the matters ejected, as they had 
done a century before. In regard to the 4th, 5th, and 6th, reasons 
mentioned by Dr. Stuart, vjk. the fever's not having ever to his know- 
ledge terminated " within a few weeks in an intermittent ;" (as happens 
sometimes to bilious remittents ;) its producing a greater degree of 
weakness; and its not admitting, at least with benefit, of an early, bold, 
and free administration of the bark, I must observe, that, to my under- 
standing, they do not oppose any obstacle to the belief of this disease 
having been the yellow fever; which seldom changes to an intermit- 
tent ; always^) roduces extreme debility ; and, in its inflammatory stage, 
before the appearance of a remission, is, I believe, always aggravated 
by taking the bark. 

As Dr. Stuart's reasons, for thinking the fever in question to have 
been a new disease, were stated with candour and precision ; and as 
they have been quoted and adopted by Dr. Chisholm, (at p. 24 of his 
letter to Dr. Haygarth,) I have chosen to answer them in preference 
to those which Dr. Chisholm has described with greater prolixity, and 







480 

T?ith a manifest effort to make this fever resemble the plague, li's 
descriptions appear, also, to have been adapted, almost exclusively, to 
the worst cases ; though he admits, that in many persons the fever 
was mild, and thought to resemble the ordinary bilious remittent. But 
the worst cases were best suited to his purpose of creating a distinction 
between these fevers;* he has, however, not only failed to establish 
any such distinction, but has even mentioned facts which prove that 
the fever of 1793 could only have been a marsh fever. The following 
are some of these facts, viz. (like all other marsh fevers it most rea- 
dily and generaVy attacker! strangers from cold or temfierate climates, 
and with the most fatal consequences ; sparing all others in different 
degrees according to their susceptibilities, as explained by me, be- 
tween pages 177 and 197. At p. 140 of the first volume of his Essay, 
Dr. Chisholm has given, in regard to this disease, what he calls a 
u scale of its violence, or the gradation it observed with respect to the 
different classes of inhabitants ;" which accords entirely with what I 
have repeatedly mentioned of the effects of marsh fever, upon similar 
descriptions of persons, in other situations. The highest place in this 
scale, is occupied by " sailors, more especially the robust and young ; 
those least accustomed to the climate, and those most given to drink- 
ing new rum." The next, by "soldiers, more especially recruits 
lately from Europe, and the most intemperate." After these come 
" white males in general lately arrived, more especially young men 

• Dr. Chisholm seems principally to rest the supposed novelty of the fever under con- 
sideration, and its character, upon a sort of petechise, or efflorescense, resembling 
patches of red or livid spots ,-" (vol. 1. p. 58) upon a " dinginess, or peculiar mixture of 
livid and a dirty yellow,'''' (mentioned by Dr. Stuart) which he (Chisholm) whimsical- 
ly ascribes to (a nonenity) " the action of the matter of infection ," (vol. I, p 76) and 
upon the frequency and profusion of hemorrhages ; (p. 166) but all these symptoms 
obviously result from a dissolved state of the blood, which as well as the symptoms them- 
selves, have been long noticed by almost every writer on the yellow fever. Dr. 
Moseley (p. 456) observes of if, that, in "the last stage," "the interior sur- 
faces of the body are all oozing out blood, into their cavities ; evi:ry excretion is cor- 
rupted blood;" "and internal ha?mo'. rhage becomes general" Hi!' 151) 
' in the latter stage of this fever, the blood is so attenuated, and dissolved, that «e fre- 
quently see it flowing not only out. of the nose and mouth, but from the eyes, and even 
through the very pores of the skin." He mentions, also, " livid spots in many pa ts of 
the body," and that they are multiplied after death. Dr. Mosde-'s description of 
Capt- JMarwhoad's case, which occurred before the Liankey existed, affords all the worst 
symptoms of the worst cases of the supposed new fever of 179.' It was not, in*' 
accompanied by Dr. Chisholm's •* dinginess, &c,'' which 1 have mentioned (at the bot- 
tom of p. 47) as someties occurring in the disease, and w hich Dr. David (irant, in 
describing the yellow fever of Jamaica, calls tc a livid hue tinged yellow. " It is remark- 
able, however, that though so much importance is now attached to this symptom. 
Chisholm, in the first Edition of his Essay, did not mention or even allude to it ; but 
contented himself with stating, as " a principal distinction," between the supposed new 
fever, and the bilious remittent, that in the former, " the yellow suffusion, seldom hap- 
pened ; in the latter always." Seep. 128 of bis first edition. The "dingin 
only to have been noticed by Dr. Chisholm, after hisreturn to the West Indies in 1796, 
when, according to his representation, the malignant pestilential fever had ceased to 
prevail there, and the common yellow fever had taken its place. 

I may here observe, that the (e\ur of 1793, at Grenada, did not differ half so much 
from the commoR yellow fever, as it, did from the fever which occurred in the Hank 
and among the colonists at Bolama ; and it must be very absurd to derive the fo<- 
from the latter, as its parent, and at the same time pretend that the supposed new 
fever, with its smaller variations from the com mon yellow fever, could not have W 
nated from the causes by which it (the yellow fever) is produced. 



481 

from Europe." The places of other descriptions of persons, will 
be readily understood by what I formerly stated of their respective 
susceptibilities, in regard to marsh miasms : always recollecting that 
females are less susceptible than males, children less than adults, and 
negroes least of all. The greater liability, or predisposition to the dis- 
ease in seamen, than in any other description of strangers, Dr. Chis- 
holm ascribes with reason, to their "violent exercise in the sun, the 
immoderate use of undiluted rum ; bathing in a state of intoxication, 
and often when violently heated ; and the sleeping on deck during the 
night." (Vol. i, p. 124.) Indeed, these causes alone will often pro- 
duce yellow fever. Dr. Chisholm has, however, suggested another, 
(p. 302,) as perhaps rendering "the disease infinitely more fatal" to 
them, than to " any other class of men," viz. — a scorbutic taint, which 
I formerly mentioned, as likely to have occasioned that variety of the 
disease called by the French mal de Siam. In regard to the military, 
at Grenada, he says, " that nearly one half of the 45th regiment" were 
in the barrack near the carenage, and that " all* the officers and men 
were successively seized with the disease ; but it proved fatal only to 
the recruits who had lately joined.''* Vol. i. p. 132. The case was 
similar in the ordnance department; of those who had become sea- 
soned, in some degree, to the climate, omy five died out of 56 ; but of 
recruits just arrived, 21 died out of 26; and this with all the advan- 
tage of Dr. Chisholm's skill, two months after he had discovered the 
wonderful benefits of mercurial salivation, in this fever. See vol. i. 
p. 133. 

After these instances of the frequency and violence with which per- 
sons newly arrived from northern climes were attacked by the disease, 
(as always happens with marsh fevers exclusively) he proceeds to the 
other extreme, and mentions field negroes, as being the most exempt 
from it ; though that mixed race called people of colour, seem to have 
enjoyed this exemption in a very high degree ; for Dr. Chisholm tells 
us, that "the inhabitants of the district of Montserrat," (and a part of 
St. George's, adjoining the carenage are almost all free people of co- 
lour ; and among them the disease never appeared, affecting their own 
persons ; many of the sick, (he adds) from the shipping, were accom- 
modated in their houses; but a peculiarity of temperament saved 
them generally." Vol. i. p. 128. This peculiarity of temperament 
might, indeed, well save them from the morbid effects of marsh mi- 
asms, as it has always been found to do, when they had not lost it, by 
long residence in a cold climate ; but negroes and people of colour, 

* It is difficult to understand what quantity, or proportion, Dr. Chisholm means by 
" alW He says, at p. 134, vol 1, of his Essay, that " about the middle of June* the 
disease broke out in the 67th regiment, and among the artifices and labourers on. 
Richmond Hill," " all were successively seized with it ; but it fell heavier on the offi- 
cers than the men ; several of the former, being young men lately arrived from Eu- 
rope. He adds, that " of about 300 men, at that time the strength of the 57th regi- 
ment, only about sixty were seized with the symptoms of infection and of that number 
only three died." Here we find that all signified only one-jifth part, ami that the dis- 
ease preved fatal only to one in twenty. Hid Dr Chisholm form hs description of the 
disease from its general appearance on Richmond Hill ? Or did he conclude the d's- 
ease to be direfutty contagious, because only 60 out of 300 men took it, and doubtless, by 
going down the hill, and within the reach of marsh miasmata ? 

61 



482 

have no peculiarity which will protect them -from the morbid effects of 
pestilential and typhus contagions ; on the contrary, they are, as has 
been proved, the first and greatest sufferers by these contagions, and 
this single fact would alone orerthrow Dr. Chisholm's whole sys- 
tem.* 

In regard to the termination of this epidemic, Dr. Chisholm states, 
(vol. 1, p. 136) that " from about the middle of September, till the 
month of February, of the year 1794, the disease seemed to have dis- 
appeared every where in Grenada." Why a contagion, with such ir- 
resistible power, should have become extinct when there was no want 
of persons susceptible of it, he has not explained ; but, in looking 
over his account of the weather we find, in vol. 1, p. 90, the follow- 
ing statement, viz. " September, the greatest part of this month re- 
markably rainy, attended frequently with most vivid lightning and 
tremendous thunder, and violent squalls" Of October, he says, 
u much rain fell in this month also," "but not in the violence of the 
last." He adds of November, " five days excepted, the whole of this 
month was uncommonly rainy ,-" " a great deal of thunder and light- 
ning." " December was also very rainy." That these excessive and 
long continued rains , assisted by the salutary effect of violent squalls, 
thunder, Sec.) should have gut a stop to the fever, by diluting the 
marsh miasms, and washing away the materials necessary for their 
production, will, I am persuaded, be thought highly probable, by 
those who may have attended to the facts mentioned in the former 
parts of this work. Concerning its return, in February, 1794, as the 
Hankey did not then return, it might have been expected that Dr. 
Chisholm would have found some difficulty in giving a suitable expla- 
nation, but having before luckily sent the contagion to Philadelphia 
by some unknown vessel, and from some place, respecting which 
there are very contradictory accounts, he contrives to have it brought 
back to Grenada, by the way of Martinico, where, after it had been 
deposited by one vessel, it was taken up by another and left at Gre- 
nada. But unluckily, though he was then at Grenada, Dr. Chisholm 
is unable even to hint at her name, or the name of her captain ; a sort 
of inability which (considering how much greater difficulties he had 
previously surmounted) I should not have expected ; especially as he 
says the sick belonging to this vessel, and by whom Grenada was the 
second time infected, were placed under his u charge ;" and that he 
11 had no doubt respecting the identity of the disease." Really, I 
should have believed that the books of himself and his partner, must 
have contained the names at least of the vessels, to which patients of 
that description belonged ; as they certainly did not bestow medicines 

* At p. 302, of his first volume, is the following passage, " why, however it" (i. e- the 
virus of his supposed contago-i") ''should operate with most violence on Europeans just 
arrived, and -who had never entered tlie Torrid Zone before, is a singularity 1 do not 
pretend to explain/' This abstinence from explanation, though unusual in Dr. Chisholm 
was, 1 think, discreet on the present occasion. Certainly, If his supposed contagion had 
existed ami manifested this wonderful predilection for Europeans, at their first entering 
the Torrid Zone, it would have bv en a singularity never observe*! in any other eontas 
s\m\ therfore well calculated to discourage him from any attempt to explain- The singu- 
'ority, however, aud the contagion, were but creatures of his own imagination 



483 

and attendance gratuitously. I should have, moreover, expected, aa> 
Dr. Chisholm had no doubt of the identity of their disease, with that 
which had recently done so much mischief, that its re-introduction 
would have been deemed by him a matter of high importance, and 
that instead of such unexampled negligence, he would have spared no 
pains to colL&ct and preserve all possible information on the subject. 

I have stated, in a note, at p. 260, that Dr. Chisholm's adherents in 
Philadelphia, convinced that they could not otherwise establish any 
distinction between what they represented as his Grenada fever, and 
the marsh bilious fever of that country, had assumed contagion as 
forming its distinguising character ; and Dr. Chisholm has followed 
their example, doubtless for the same reason. At p. 200, vol. 1, he 
says, " the most remarkable distinction between the malignant pesti- 
lential fever, and the yellow remitting, is contagion;" this assertion he 
repeats at the next page, and then very properly endeavours to prove 
the existence of this contagion ; but here he unfortunately adduces for 
his first and principal proofs of it, the absurd story concerning the ship 
Herberts, lately noticed ; and his equally absurd notion " that much 
of the melancholy fate of the army collected at the Cove of Cork, un- 
der major-general White, about the. end of the year 1795, for St. 
Domingo, is to be attributed to the infection of the malignant pesti- 
lential fever." Thus making yellow fever the parent of tyfihus. These 
being evidently, in his own estimation, his best proofs and instances 
of the contagion, which is supposed to distinguish the fever of 1793, 
I shall not be expected to notice the others, after all that I have before 
written on this subject. 

Dr. Stuart, in his letter to Dr, Kosac.k, mentions of this fever* 
that "its contagious nature appeared from many instances of men in 
1793-1794, going to St. George's on business, and being attacked a 
few days after their return to the country, with fever ; to several of 
whom it proved fatal." This, however, is only what commonly hap- 
pens to persons, exposing themselves to the influence of marsh mias- 
mata; and what has been often described, as happening to persons going 
into towns where the common yellow fever prevailed, long before the 
Hankey existed ; which yellow fever, Dr. Stuart (as well as Dr. 
Chisholm) believes never to have been contagious. Dr. Stuart, in- 
deed, with laudable candour, makes this addition to what has been just 
quoted from his letter, viz. " but I must observe that I met with no 
instance in the country, of the disease being communicated to others, 
either visitors or attendants. It is true that every attention was paid to 
keep the chamber of the sick well aired, their linen frequently shifted, 
and when a fatal issue took place, every article of wearing apparel and 
bedding was commonly destroyed." This destruction, however, was 
probably of no use, as it only took place in fatal cases, and not invariably 
even in these, as I conclude from the expression " commonly ;" and 
as the cases which were not fatal, would have equally intected the un- 
destroyed clothes and bedding, from which no harm resulted. The 
airing of # the sick apartments might, indeed, have been effectual, 
against typhus ; but not against any such virulent and powerful conta- 
gion as the Hankey is supposed to have imported. This part of Dr. 
Stuart's statement is confirmed by Dr. James Clark, in regard to the 



484 

*ever which began at Dominica, in June, 1793, and which Drs. Stuart' 
and Chisholm suppose to have been the same with that of Grenada, 
and derived from the same source. Dr. Clark's statement on this 
point I have already quoted at p. 296, and I may add that as no pre- 
cautions were there employed to hinder the operation of contagion, I 
am persuaded that if none had been used at Grenada§ the fever would 
have proved equally incommunicable. Dr. Clark says, (p. 61; "that 
the common remittent fever, dysentery, and other bilious complaints, 
had begun to shew themselves previous to the appearance of the yel- 
low fever" in 1793; a plain indication of the prevalent influence of 
marsh miasms. The same author, at p. 22, makes the following ob- 
servations concerning the supposed new fever, viz. " I have been in- 
formed that it has been considered, by some, as an imported and very 
infectious disease ; but in this island it did not appear to be either im- 
ported or infectious. The very few instances which seemed to indi- 
cate contagion, I mink, may be accounted for on other principles. 
Some inhabitants, who had been accustomed to breathe a cool healthy 
air, in high situations in the country, were sometimes attacked after a 
visit to town in the same maimer as new comers from Europe and 
America, who never had been in the West Indies before ; the reason 
of which will be enquired into hereafter. Those who had resided long 
in town, or near the sea side, were not attacked with it. The physi- 
cians and surgeons who visited the sick, and the nurses who attended 
them constantly, were not infected ; nor did there occur a single in- { - 
stance, of one of them being seized with this fever for these three 
years, that I have remained in the island, since it broke out : although 
no prophylactic, or precaution of any sort whatever, was made use 
of to counteract or avoid contagion. I am, therefore, of opinion, that 
this terrible disease was not imported into this or any other of these 
islands, or into America; but that it was produced from natural 
causes."* Of Dr. Clark, Dr. Chisholm has stated, at p. 258 of his 
2d volume, that he was " a physician of great eminence, whose prac- 
tice for five and twenty years, in the West Indies, furnished a most 
ample field for observation and experience ;" and it appears that he 
was not singular in believing that the fever in question was not conta- 
gious. For Dr. Chisholm states, (vol. 2, p. 254) that "Dr. Fillan," 
who " has been an eminent practitioner in Dominica, for near twenty 
years," " imagmed he could perceive nothing contagious or infectious 
about it, i. e. the new fever :" this negative exercise of the imagina- 
tion, however, is at least unusual ; persons having much oftener ima- 
gined they could perceive what does exist, than the reverse. It ap- 
pears, indeed, that it was not Dr. Fillan who thus exercised his ima- 
gination, but Dr. Chisholm, who thought it most convenient to repre- 
sent Dr. Fillan as having only imagined, when in fact he had asserted, 
that he could perceive nothing contagious, Sec. for he immediately 
subjoins the following sentence, viz. " on questioning the doctor close- 

* Dr Roberts, Physician to the forces, who was at Grenada during the great mortality 
there, in 1796, and who, probably, saw more than lOOi » cases of the supposed indignant pes- 
tilential fever, declares that he could discover no sufficient reason for considering; it as a 
disease different from the common yellow fever of the "West ludies, with which he was 
well acquainted ; having been born at Antigua. 



485 . 

ly on this subject, I perceived that no conclusive or well-founded rea^ 
soiling could be adduced in support of this assertion'* That Dr. 
Chisholm should not think any reasoning conclusive or well-founded, 
which had induced another person to imagine he could not perceive 
that contagion, which has so long occupied and bewildered his own 
imagination, I can readily believe ; and though I cannot applaud the 
candour of his statement, I am glad that it contains less of misrepresen- 
tation than many of those which I have found it necessary to controvert. 
But though Dr. Chisholm could not, by " closely questioning," hin- 
der Dr. Fillan from asserting his inability to discover any appearance 
of contagion in the supposed new fever, he seems, from his own ac- 
count, to have been a little more successful with Dr. Fillan's " assis- 
tant." For the latter, (who is styled, by Dr. Chisholm, an " eminent 
practitioner") after declaring that he had neglected to make any " in- 
quiry so as to establish the source of the disease in any instances," is 
said to have readily " acknowledged, that had an investigation been in- 
stituted, with the care and attention the subject merited, he had rea- 
son" (where did he get this reason) "to think that contagion might 
have been detected, as the cause of the disease, in every instance." 
If Dr. Chisholm has not misrepresented this (probably young) gen- 
tleman's language, it may be well that his complaisance, or his imagi- 
nation, did not carry him farther.* 

But after all this, Dr. Chisholm, who has repeatedly stated his sup- 
posed new fever, or its contagion, to have been carried from Grenada 
to Dominica, (though without designating any mode, or vehicle, or 
person, by whom this mischief was perpetrated,) tells us, at p. 256 of 
his 2nd vol. that " the first appearance of the disease (at Dominica) 
was in a ship, called the Providence of London. She arrived (he adds) 
about the 8th or 9th of June, and the first case of fever appeared about 
the 1 3th : many of the crew were attacked immediately after, and died. 
The fever appeared in the neighbouring ships, and spread so rapidly, 
that .about the 20th, scarce any were free from it." And this^ Dr. 
Chisholm (whose intellectual and perceptive faculties appear inacessi- 
ble to all ideas, which do no* accord with his supposed contagion,) 
considers as a proof, that the disease was communicated from the sick 
to the well, and from one ship to another, in succession ; and all in the 
space of one week. A monstrous supposition! utterly incompatible 
with every thing known of the different kinds of contagion; among 

* A.s an illustration of the truth of this remark, I will here mention a statement made 
by Dr. Chisholm (at p. 257, of vol. 2d.) on the ^formation, as he alleges, of Dr. Fillan's 
assistant It relates to a Dr. Wilson at Dominica, who resided about 12 miles from 
town, and who three days after returning to the country from town, wh^fe he had visited 
persons labouring under the prevailing fever, was astonished to perceive a number.of 
carbuJicfes, spreading round his neck, and towards his face and breast. The progress of 
these was so great, as to threaten a mortification. In this distress, he sent an express for 
Dr. Johnson. Dr. Fillan's assistant "who immediately visited him. By the time he 
arrived a mortification had actually taken place, and Dr. Wilson died a few hours after, 
•whilst endeavouring to examine the state of his neck in a looking glass. The description 
of the sores on this patient's neck, says Dr. Chisholm, left no room to doubt they were 
pestilential carbuncles." Thus has Dr. Cliisholra's heated, distempered imagination, 
created the true plague at Dominica ; and that it might not be created in vain, lie imme- 
diately adds that " an immense number of the inhabitants were seized and many died." 
Is it possible that he can h<ive believed and wished to make others believe, that these 
persons died of the true plague ? 



486 

which, there is scarcely one, that could have so soon produced disease, 
even in two persons successively. When ships are placed within the 
reach of those miasms, or local causes of disease, which, at certain 
times, commonly produce the yellow or other marsh fevers, in the har- 
bours of the West Indies, their crews being acted upon, nearly at the 
same time, by the morbid exhalations, many persons will naturally fall 
sick almost simultaneously : and nothing but such a cause, could have 
produced the effects just mentioned, as having occurred at Dominica. 
But how Dr. Chisholm expected to reconcile the first appearance of the 
disease, in a London ship, just arrived at Dominica, with his assertion 
of its having been derived from Grenada, I am unable to conceive. 

Believing that it would be not only superfluous, but tiresome to my 
readers, as well as to myself, if I were to carry this refutation any far- 
ther; and presuming, that I have sufficiently demonstrated the fallacy 
of all those statements and arguments, by which Dr. Chisholm has la- 
boured to prove the fever in question to have been derived from the 
Hankey; and "that there is no good reason for considering it as specifi- 
cally different from the common yellow, and other marsh fevers, which 
have been proved to be void of contagion, I shall here dismiss the sub- 
ject; adding only a few observations, to justify the uncourteous and 
disobliging expressions which I have been sometimes forced to employ, 
in regard to Dr. Chisholm. Had this gentleman contented himself 
with stating fairly and c orrecfly, the facts and reasonings which occa- 
sioned, and were by him thought capable of supporting his most 
extraordinary opinions. I should have left the public to judge of their 
sufficiency, and have gladly avoided every appearance of controversy 
with him. But instead of doing that, which would have most benefited 
the cause of truth, and the interests of mankind, Dr. Chisholm, widi 
great perseverance, and very little temperance or moderation, has la- 
boured to propagate and maintain these opinions, by assertions as 
positive as they were unwarranted; and by statements of pretended 
facts, which were destitute of any foundation in truth, and at the same 
time of such decisive import, that a belief of them, must necessarily 
produce an adoption of the opinions intended to be thus maintained ; 
which opinions, I sincerely believe to be not only erroneous, but likely 
to obstruct the progress of medical science; perplex and frustrate all 
endeavours to elucidate the important subject of contagion ; and, more- 
over, to produce all those mischievons consequences which I h 
mentioned at p. 332 — 336. Under this conviction, I have thought it 
my duty, to endeavour, at least, to rescue and vindicate the truth,* 
from those fallacious arguments, and confident misrepresentations, with 
which it has neen surrounded and obscured, by Dr. Chisholm ; and for 
this purpose, to contradict, and confute the untruths advanced, [\ will 
not say fabricated,) by him; and demonstrate die little reliance which 
(either from his extreme want of caution, or excessive anxiety to over- 
come his opponents,) ought to be placed on his supposed facts and 
representations, in regard to the origin and nature of the fever of 1 ' 

* Dr. Chisholm, at p. 219 of his 1st vol. has declared, that " th troth is 

paramount to all other consideration*," and has assigned this as his 
t ion, tor contradicting Dr Rush: professing, at the same time, to 
opinion of "the humanity, the genius, and the professional skill of t 



487 

I*or such contradictions and confutations, I have found it necessary to 
employ adequate terms ; but I have done it reluctantly, and have in- 
variably preferred the least offensive, as far as I could do so, with- 
out weakening my conclusions, or leaving my ideas imperfectly ex- 
pressed. 

This explanation I have thought due to my own character, rather 
than to Dr. Chisholm. For, whilst endeavouring to spare his feel- 
ings, I have believed that very few writers were less entitled to in- 
dulgence and tenderness in this respect: because, with a few excep- 
tions, he seems to have exercised neither towards those by whom his 
statements and opinions are controverted. His Letter to Dr. Haygarth 
abounds in offensive, arrogant, and injurious language, particularly at 
p. 75, where he designates the most respected and meritorious physi* 
cians of New-York and Philadelphia, as " pertinacious theorists." — 
" Distm bers and destroyers of society :" — and as deserving " to be 
execrated by their fellow citizens :" and this, only because they had 
controverted his opinions, respecting the fever of 1793. And again, 
at p. 159, he has generally accused all who deny the supposed conta- 
gion of that fever, of u a predetermination to break down the barriers, 
which alone can secure mankind against the calamities" arising from 
" infection and contagion" " universally diffused, and universally 
destructive of the human race" He had previously, in his preface to 
the 2nd edition of his Essay, plainly intimated, that the " Medical Staff'* 
of the army, under Sir Ralph Abercrombie, in the West Indies, were 
chargeable, in a great degree, with the deaths of 13,437 soldiers; and, 
at p. 243 of that volume, he has accused them of a species of " con- 
duct, which led to the pernicious, indolent, and unscientific habit, of pre- 
scribing for the name of a disease :" — " prevented the investigation of the 
principles on which practice, in any particular distemper, should be 
founded;" — " which tended to the discredit of a mode of treatment of 
the epidemic, from which alone, success could be expected :" and 
which was, u in short, the paramount cause of the mortality which 
has disgraced the annals of the'West India Medical Staff of the day."* 
The foundation of these outrageous accusations, and the delinquency 
to which they relate, is nothing more than a belief or pretence, in Dr. 
Chisholm, that the medical officers of the army in question, did not 
sufficiently adopt and persevere in the practice recommended by him, 
of giving or applying mercury to excite salivation, in the yellow fever ; 
a practice, of which I have delivered my opinion, at p. 73 — 78; and I 
will here observe, as one of the physicians to that army, that there was 
nothing in Dr. Chisholm's situation, which could make it our duty, or- 
even warrant us, to persevere unsuccessfully, in the trial of his strange 
and unpromising innovation.! He had only been known as a practi* 

* The mortality with which the medical officers of Sir Ralph Abercrombie's army are 
v here reproached, was certainly great, and ever to be deplored ; but it did not, in any 
instance, extend to '21 out of 26 patients, as happened to persons under Dr. Chisholm's 
eare, after his pretended discovery of an almost certain remedy. 

"j" Tt is remarkable, that while Dr. Chisholm brings such heavy accusations against the 
med : cal office rs of the army, for not having sufficiently ernployed mercury to cure the 
yellow fever, Dr. Gillespie, who was then in charge of the naval hospital -at* Fort Royal, 
jn Mrrtinico, declares, 'that many of these gentlemen fell victims to their : mplicit faith 
ih mercurial medicines which had been lately snpposed so efficacious in epidemics, of a 



488 

tiofter at Grenada ; and when there, could not have pretended, to an, 
equality with several others, in public estimation. Nor-did I find that 
his boasted success at that island, from the use of mercury in the yel- 
low fever, had been known there, until his printed accounts of it had 
arrived from Europe, nor that it was believed when thus made 
known. I feel, however, no resentment against Dr. Chisholm, for 
the obloquy which he has thus attempted unjustly to throw upon me 
among others, though I sincerely regret, that his acknowledged talents 
and industry, were not more judiciously and beneficially employed. 

similar nature to those which then reigned." Meaning the Grenada fever, and Dr. Chis- 
holmV <c vnit of t. See Observations on the Diseases," &cc "of his majesty's Squad- 
ron, on the Leeward Island station," &c.p. 19- 



APPENDIX. 

NO. VIII. 



At pages 204* and 205, I have explained the subject' and motives 
of this appendix; and the following is Dr. Blane's statement, (therein 
mentioned, to the American and Prussian ministers, viz. 

"On the 16th of May, 1795, the Thetis and Hussar frigates, cap 
tured two French armed ships from Guadaloupe, on the coast of Ame- 
rica. One of these had the yellow fever on board, and out of fourteen 
men sent from the Hussar to take care of her, nine died of this fever 
before she reached Halifax, on the 28th of the same month, and the five 
others were sent to the hospital, sick of the same distemper. Part of 
the prisoners were removed on board of the Hussar, and though care 
was taken to select those seemingly in perfect health, the disease spread 
rapidly in that ship, so that near one third of the whole crew was more 
or less affectedly it. 

" This fact carries a conviction of the reality of infection, as irresisti- 
ble as volumes of argument ; and, it further affords matterof important 
and instructive information, by proving that the infection may be con- 
veyed by the person or clothes of men in health" 

Numerous facts and considerations, most of which have been already 
mentioned, having induced me to think it impossible, that the yellow 



489 

fever should have in this instance manifested properties, which it ha$ 
been found not to possess in a multitude of others, I was solicitous to 
investigate the circumstances of this transaction, as minutely as possi- 
ble, in order to ascertain the truth, on a point which I have long con- 
sidered as of high importance to mankind ; and I therefore applied to 
the commissioners of the transport department, for permission to in- 
spect the medical journals of the surgeons of his majesty's ships Thetis 
and Hussar, for the year 1795, and the correspondence of the surgeons 
of those ships with the sick and wounded board, for the same period, 
and was very soon honoured by a letter from Sir Rupert George, Mr. 
Serle, and Dr. Harness, dated 14th October, 1807, and informing me 
that " the journals were ready for my inspection, but that there did not 
appear to have been any letters received from the surgeons of those 
ships during that period." I lost no time in availing myself of this per- 
mission ; but as the journals in question did not afford all the desired 
information, I extended my researches to the navy office; after which, 
I thought it my duty, fairly to communicate the results of my inquiries 
to Dr. Blane; and having done so, he thought it proper to write the 
following letter to Dr. Wilson, now physician to the Plymouth hospital, 
and formerly surgeon to the Hussar frigate, viz : 

"London, Nov. 17, 1807. 
" Sir, 
a You may possibly have seen, in some of my writings, that I have 
adduced as a proof of the infectious nature of the yellow fever, that it 
spread from the Raison, French prize, to the Hussar frigate, in May, 
1795. There is, in my opinion, sufficient proof of this fact from other 
quarters, but as you were then surgeon of the Hussar, and as I find by 
my notes, that it was partly on your testimouy that I built, I take the 
liberty of putting some questions to you on this subject. What leads 
to this is, that Dr. Bancroft, a respectable medical gentleman of this 
place, who has paid much attention to the subject of infection, but who 
is of a different opinion from me on this point, means to controvert my 
statements of that case, and founds his proofs chiefly on your journal, 
which he has not only inspected, but has copied it for the months of 
May and June, 1795, and has very candidly called on me, and shown 
it me. There is certainly nothing in that part of your journal which 
can be construed into a proof, that the slrp's company of the Hussar 
had the same fever with the prisoners. But the composition of it bears 
marks of very great haste; and no description of the symptoms is 
given, except a reference to the case of Mr. Backhouse, who was not 
taken ill till a month after the battle, and whose symptoms have nothing 
characteristic of the yellow fever. I am sure, however, from my notes, 
that either in some other parts of your journal, or in those accompany- 
ing remarks, enjoined by the form of the journal, or in your letters 
from the hospital, there must have been seme further testimony from 
you on this subject. The purpose of this letter, therefore, is to request 
you to consult your memory, and your papers, regarding it. You will 
certainly recollect, whether or not, the men of the Hussar, either on 
board, or at the hospital, were affected with a fever attended with yel- 
lowness of the skin, and coffee-coloured vomiting, and in what num- 
bers; also, whether only the prisoners apparently in health, or both the 

62 



490 

sick and healthy, were brought on board of your ship ? If ycu should 
be able to give any satisfactory information, either for, or against, these 
facts, I should hold myself extremely obliged to you, and I am sure so 
would Dr. Bancroft, in order that neither of us may be led into error, 
in so material a point. There is a reference in your journal, to some 
letter you wrote from the hospital, but as Dr. Bancroft could not find it, 
it has, no doubt, been mislaid at the office ; but it would be a great sa- 
tisfaction to us, if you should have kept a copy of it. In short, if you 
will have the kindness to send all the information on this affair, which 
your memory, or written documents, can supply, and your time will af- 
ford, you will greatly oblige 

Sir, your most obedient, 

and very humble servant, 

GIL. BLAXE. 
" Dr. Wilson-, Plymouth Hospital. 

u P. S. I ought to have mentioned that Dr. Bancroft has also in- 
spected the muster-books of the Hussar, at the navy office, and finds 
the prisoners in sickness as well as health were brought on board the 
Hussar, contrary to what I have stated in my letter to the American 
and Prussian ministers, which you may probably have seen in print" 
To this letter the following answer was returned, viz : 

" Royal Navy Hospital, Plymouth, jYov.22, 1807. 
" Dear Sir, 

u I am much afraid I have lost the journal of the sick kept by me, at 
the time the yellow fever prevailed on board the Hussar; I have, how- 
ever, found a copy of the letter, which I transmitted to the sick and hurt 
board, on that occasion. I have, agreeably to your wishes, transcribed 
the greatest part of it, and herewith enclose it for your perusal ; if 
plain matter of fact can have any weight, you will there find sufficient 
to establish fully your observations on the contagious nature of that dis- 
ease. Should any other testimony be wanting, by a reference to capt. 
Beresford, who then commanded the Hussar, and now commands the 
Theseus, further particulars may be obtained. 

" Mr. Backhouse was subject to frequent attacks of chronic rheuma- 
tism ; was, in consequence, sent to the hospital at Halifax; — first, on 
the 27th of June, 1794 — and again in November following. Many 
were afterwards, at different periods, sent for the same complaint, and 
particularly two on the 2St h of May ;— one on ihe first, and another on 
the 17th of June, 1795.* Their treatment being nearly the same 
that of Mr. B. a reference, in order to avoid repetition, was in conse- 
quence always made to his case. This, I trust, will explain, why no 
symptoms, in common with yellow fever, could be found in the cases 
ailuded to, or any thing that could lead one to believe, the Hussar's 
ship's company to have the same fever with the prisoners. 

* This accords with Dr. Wilson's Journal ; but in his subsequent letter to Dr. Diane, 
he admits, that the entry relating to the 17th of June, could not have been correct ; "as 
from the Gth of that month, to the 4th of July following, we (the Huss\u-) had no com- 
munication whatever with the hospital." It must consequently follow, that the entry in 
his journal of another name, as sent to the hospital, the 20th June, must also be M 
rect 



491 

" I do not recollect the number of prisoners received on board the 
Hussar: I only remember, that the sick were not removed from the 
Raison ; that they remained in the prize until her arrival in port, 
and that it was only those in health that were permitted to come 
on board of us ; the names of the sick, as well of those in health, 
were, as is customary in such cases, indiscriminately entered on the 
books of the Hussar* 

"The number of the Hussar's ship's company affected with the 
disease, appears to have been 98. The number of deaths on board 
the Raison, between the 16th and 28th of May, were (was) . . 9 

The number of deaths at the hospital, between the 28th of May 
and 6th of June 6f 

"Total 15 
" The above will, I believe, be found a correct statement. 

" I am, dear Sir, &c. n 

" J. Wilson. 
" To Dr. Blane." 

* The only way in which I can reconcile this with the opposite testimony, is by suppo- 
sing, what appears in other respects probable, that there were no sick on board La Rai- 
son. 1 found, by the books at the jYavy Office, that u head money'''' had been paid to the 
captors for 116 prisoners, as having been on board the Raison, at the commencement of 
the action ; and it appeal's from the "master-book of the Hussar, that she received the same 
full numberof 116 men on board, from La Raison, on the 16th of May, and that every one 
of these men were delivered from the Hussar to t/ie Security, prison ship, at Halifax, on 
the 28th of May ; consequently none had been killed in, or died subsequently to the en- 
gagement of the lfith of that month. Their names are all stated in the book at full 
length ; and under them is" a certificate, signed by John Beresford, captain, and Francis 
Prior, declaring " to the Commissioners for Victualling his majesty's INavy," " that the 
before-mentioned prisoners, beginning with the name of A. L. Le Sau, and ending with 
thatot Anthony Pignon, were actually victualled sit two-thirds allowance, the numberof 
days as specified by the several entries and discharges." These entries and discharges 
include all the days from the 10th to the '28lh of May ; and aginst the names is a column, 
for them when mustered, and in this column the 23d of May is written against 
each name, or the letters Do. under that date. I inquired particularly of the gen- 
tleman at the office, whether it might not be possible that these letters should 
be .'ffixed to the names of some of the prisoners who had remained on board the 
Raison, and was answered in the negative ; with an assurance, that every man against 
whose name those letters were written, must have been actually on board ; and that if 
any man had been sick, so as not to receive his allowance, or absent from the Hussar for 
a single day, it would have been noted m the column, or "checked," as they express it : 
and in confirmation of this, 1 was shewn several instances of such checking, in the books. 
It is to be recollected, that the "two-thirds*'' is the full allowance to prisoners in health ; 
and it would have been fraudulent to make a false entry in this respect : and, moreover, 
it is highly probable, that they must have been in health, because at Halifax they weii: all 
sent, not to the hospital, but the prison ship ; and none were sent thence to the hospital 
until three days after ; and even at that time, it does not appear that a'iy one sent was iil 
of fever. That they would have been sent earlier from the priSon-ship (o the hospital, if 
they had be<n ill sooner, is manifest, because two of the Prevoyante's crew were sent 
from the prison ship to the hospital, one the 29th of May, and another on the 80th, as 
appears by the hospital books, and being all prisoners made at one time, and in the same 
circumstances ; the men belonging to the Raison, if any had been ill on those days, would 
have naturally been sent at the same time- 

f Dr. Wilson has stated and admitted, several times, what the books of the hospi- 
tal at Halifax prove, that the whole number of men belonging to the Hussar, who. 
were sent to this hospital, in May and June, 1795, amounted only to 12; and, in his 
Letter to Dr. Blane, of December 20th, 1807, he declares, that six of these were sen* 
back to him, on the 6th of June, and that they all recovered. He also states, that 
two of the remaining six, were cases of rheumatism, in the persons of David Sullivan 
and Nicholas Martial, who, by Dr. Wilson's Journal, are stated to, have been pat on 



492 

The following is a copy of the transeri/it, mentioned in the preced- 
ing letter, of " the greatest" part of Mr. Wilson's Letter u to the Sick 
and Hurt Board," viz. — 

" On the 16th of May, 1795, his Majesty's ships Thetis and Hus- 
sar, cruizing off the Cape of Virginia, fell in with five French armed 
ships, two of them, after a severe action of about an hour and a half, 
struck ; they had sailed some time before from Guadaloupe, where the 
yellow lever had prevailed, and had carried off numbers of the French ; 
unfortunately for us, La Raison, the ship we took possession of, had 
suffered greatly from this disease; several of her crew having died on 
the passage, and at this time many were found confined to their beds, 
in a state of the greatest debility* Capt. Beresford, in order to pre- 
vent, if possible, the Hussar's ship's company being infected, ordered 
all the prisoners who had the least appearance of disease, to remain 
where they were, and those only who appeared to be in a perfect state 
of health were allowed to come on board of us. Frequent communi- 
cation was, however, found unavoidable; and, notwithstanding every 
precaution was taken, I was extremely sorry to find, that before we 
reached Halifax, we began to experience the sad effects of the con- 
tagious nature of this disease. And of fourteen fine, young, healthy- 
seamen, widi officers, Sec. ordered to conduct the prize into port, five 
only survived their arrival;! and four of those in so debilitated a state, 
as to render it necessary to send them without loss of time to the hos- 
pital, together with six others, that had been affected with the same 
complaint on board the Hussar. The disease now began to assume 
so serious an appearance, that it was deemed proper to send them on 
shore the moment they comfilained, where few survived longer than 
three or four days.\ 

the sick list of the Hussar; one on the 1st, and the other on the 4th, of Mar: and 
they continued sick, and were sent to the hospital at Halifax, on the 28th of that month, 
and entered — enhen of fever in the hospital books. Rut :ts neither of them diet], the 
deaths in the hospital could only have been four, and not sir, as is here stated. It b 
moreover to be remarked, that though these two men are suited to have been const 
on the sick list in .May, Dr Wilson, in contradiction to his own Journal, asserts, in his 
Letter to Dr Mane, of the '20th of Dtoeemfcer, 1 S<>7, " that for some time prrt'ious to the 
action of the 16th of May, 1795, there had not been a man on the I/tueur's sick list* 

* In the preceding note, 1 have stated documents aud reasons, which make it impossi- 
ble for me, at least, to believe that this can be correct ; and this impossibility will b 
creased, by facts to be adduced hereafter. 

+ Facts are here equivocally, or obscurely stated ; — nine only of the Hnssar'screw died 
on board the liaison. We are no where inform. -d, how many officers were put on 
board that ship, in addition to the 14 seamen. But it appears thai no person of that des- 
cription, either died, or sickened, by going on that service 

i Dr. Wilson here admits what may be otherwise sufficiently proved, that ten of the 
Huzzar's crew went to the naval hospital, at Halifax, ill of the supposed yellow f< \ 
Done of them, however, as appears by his own Journal, was sent until nftt r two daya 
illness Of these ten men, he states in his letter to Dr. Blane, of the -JOth December, 
1807. that he received back six, oi the 6th day of June, and that they all recovered. It 
appears also, by the books of the naval hospital, at Halifax, and by a letter to the com- 
missioners of Sick and hurt seamen, written by Sir. Haliburton, surgeon to that hospital, 
and Hated the -25th of June, 1795, that at the date of this letter, only three persons had 
died there, of the supposed yellow fever ; and, in fact, no more than four did die, in the 
who'e, of that fever, at Halifax ; and this fourth man appears, by the books of the hospital 
to have relapsed, and died on the 30th of June. With a know iedgebf these facts, I have 
felt no little astonishment, at finding that Dr. Wilson had permitted himself to 



493 

u The idea of an infectious disease, which had in so short a time 
proved fatal to so many seamen, alarmed the inhabitants of Halifax and 
its vicinity to such a degree, that they made application to Captain 
Roddam Home, commanding his majesty's ship Africa, and then senior 
officer in port, to order the Hussar, officers, and ship's company, to- 
gether with those yet alive at the hospital, to be removed to the oppo- 
site uninhabited shore : the request was immediately complied with. 
Tents were erected for their accommodation ; and on the morning of 
the 6th of June, 1795, at day-light, the Hussar was anchored at the 
place pointed out for that purpose. The following is an extract from 
the Physical Journal kept by me, during the time the sick were under 
my care; the symfitoms of those taken ill when on shore, were ob- 
served to be the same as in those Jirst taken ill on board the Hussar 
and Raison. 

" On the commencement of the disease, the patients were, in general, 
costive, and complained of great lassitude, giddiness, sickness at sto- 
mach, frequent sighing, cold chills, succeeded by a burning heat all over 
the body, and affecting the whole of the prima via ; a hot dry skin ; pain 
and oppression about the procordia; pain in the head, back, and loins; 
pulse rather quick and full, with a considerable throbbing of the tem- 
poral arteries ; a constant vomiting of at first a yellow, ancl afterwards, 
of a very dark-coloured bilious matter ; eyes red, full, and heavy; 
thirst great; tongue much furred; teeth incrusted with a dark-co- 
loured gummy substance; a yellow suffusion of the skin ; great pros- 
tration of strength ; restlessness; delirium, See. 8c c* The above were 

the Commissioners of Sick and Hurt Seamen, that from the very serious nature of the 
disorder, it had heen deemed proper to send them, the sick, on shore the moment they 
complained ,-" and that there (on shore) •* few survived longer than three or four days." 
Nine of die ten persons in question were sent on shore on the 28th of May ; and exactly 
four weeks after, three only of the ten had died. Few, is generally understood, at most, 
to mean the smaller number ; but here, more than two-thirds had survived, not merely 
three or four days, but as many weeks. In making this computation, I have taken facts 
most favourably for L)r. Wilson — because, in addition to the ten persons here mentioned, 
nine seamen belonging to the Thetis, who were sent on board the liaison, tosupply the 
place of the Huzzar's men, when sick or dead, had also been sent (of lie naval hospital 
•with the same fever, where they all recovered; and these, I should suppose, ought also 
to have heen taken into L)r. Wilson's consideration, when he thought proper to state 
that few had survived longer than three or four days. 

* Many circumstances convince me, that it is proper to receive this general account of 
the symptoms of the supposed yellow fever with great caution. Indeed, the imagina- 
tions of some persons at Halifax, appear, on that occasion, as at Grenada, in regard to the 
llankcy, to have acquired a morbid activity and bias Even Mr. Halliburton, the supe- 
rior medical officer of the navy on that station, has, I think, dearly manifested this, in his 
letter to the Commissioners of Sick and Hurt Seamen, though written on the 25th of 
June, when all apprehensions of danger had subsided, and sober common sense might 
have been expected to regain its proper ascendency. Among other instances ot the 
effect of his excessive alarm, he states the following, viz — "I went on board the Huzzur 
■with Captain Beresford, had all hands turned up, spoke to the men of the absolute ne- 
cessity of their not concealing their complaints, if they had any ; that their safety depended 
on a?i early application. Six of them came forward, with evident symptoms of the ap- 
proaching malady, and although at -work, I recommended it to Capt. Beresford to send 
them instantly to the suspected tents ; and in the evening when I visited them, I found 
three of them very ill, with quick pulse, vomiting, Sec." How much of the illness in these 
three men depended upon their imaginations, or the imagination of Mr. Halliburton, I 
know not ; but if the symptoms of yellow fever had been so evident in the six men, as 
he states, we might expect that he would have found more than three of them very ill 
ihat evening. And, I will add, moreover, my belief, that if a distempered imagination, or 



494 

the symptoms, as they in general occurred in succession. But, Gen- 
tlemen, previous to my submitting to your consideration the mode of 
treatment adopted on this occasion, permit me to make a few observa- 
tions. 

" On the first appearance of acute diseases, in general, the evacua- 
tion of the alimentary canal, becomes a primary object ; and in no 
complaint, whatever, is this maxim to be attended to, more than in the 
disease at present under consideration. In its early stages, I have often 
experienced the good effect of emetics and cathartics; but when the 
former were too often repeated, they were found to be productive of 
the most serious evils; that they not only increased the irritable state 
of the stomach, but also, that of the hepatic system ; and that in con- 
sequence, a train of such disagreeable symptoms obtained, as frequent- 
ly baffled every effort of cither medicine or art to get the better of. 

" On the first attack of the disease, the patient, if of a full habit of 
body, was bled, head shaved, a blister applied to the breast, and an eme- 
tic, consisting of 2 or 3 grains of tartarized antimony, given ; but in 
order to avoid the bad consequences above alluded to, the emetic 
was seldom, if ever, repeated; nor was any liquor allowed to be 
drank during its operation. A considerable quantity of bilious mat- 
ter was, in general, thrown up ; the spasm on the extreme vessels, in 
some measure, removed, and a stool or two frequently procured. In 
cases where this last circumstance did not take place, injections were 
had recourse to, and often without effect; calomel, however, from 10 
to 20 grains, seldom failed in procuring some free passages. Could 
the stomach have borne a sufficient quantity of the kali tartarizat, or 
any other neutral salt, I am fully of opinion every pui-pose would have 
been equally well answered. The pain and oppression about the prae- 
cordia, and laborious respiration, were much relieved by the bleeding 
and blister ; and in cases where the vomiting was very severe and pain- 
ful, saline medicines, combined with camphor, jether, and opium, af- 
forded relief: saline draughts (with opium,) in a state of effervescence, 
were also of infinite service; and those with whom the vomiting, to- 
gether with the burning heat of the prima via, continued, by taking 
three or four grains of nitre, with a few drops of laudanum, in a wine 
glass of cold water, or lemonade, every hour, although ejected almost 
as soon as drank, yet, by persevering in its use for eight or ten hours, 
found the irritation at the stomach, in some measure, removed, and 
the febrile action considerably abated. Purgatives, whenever they 
could, with any prospect of effect be given, were administered, and 
several passages, if possible, daily insured. When, however, the vio- 
lent heat, and morbid action could not, by these means, be subdued, 
much benefit was derived from the cold affusion. The manner in 
which I used it was as follows : The patient was stripped perfectly na- 
ked, and if violent, held, whilst sea water from a bucket, was poured 

something; else, had not overpowered Mr. Halliburton's sober judgment, he never 
would have thus mentioned evident symptoms of an approaching yel/oro fever in men 
who were quietly at work, rod seemingly had no suspicion of being unwell, until fright- 
ened into a belief of their being so. Other physicians often find it difficult to ascertain 
whether a fever will prove to be a vellow fever, even sometime after its actual ctmmenct- 
mwt. 



495 

on his headland all over his body, until, if delirious, he came a little 
rational, which was, in general, in the course often or fifteen minutes, 
(if not delirious, not so long ;) the affusion was then discontinued, the 
patient rubbed dry, with coarse flannel cloths, and put to bed. Sleep, 
and a gentle diaphoresis, usually followed, and the patient awoke in the 
course of a few hours, apparently much refreshed, and free from ei- 
ther fever or delirium. On a return of these complaints, the same re- 
medy was again, or again, if necessary, had recourse to, and invariably 
with the same effect. Tonics, consisting of bark, wine, Sec. &c. with a 
proper nourishing diet, soon perfected the cure ; and, I have great sa- 
tisfaction in adding, that of those who were under my care on shore, 
amounting in number to 83, 1 did not lose a single patient. 

"J. W." 

The preceding communications from Dr. Wilson, afforded me but 
little information, which was either new or satisfactory. In the hope, 
however, of obtaining more, I stated, in a letter to Dr. Blane, several 
new difficulties and objections, which had occurred to my mind on the 
subject, together with fourteen questions, which I thought it probable 
Dr. Wilson might be able to answer from memory, (if no written evi- 
dence should be in his possession,) and which I conceived likely, and 
necessary, to ascertain the symptoms and nature of the disease, and 
supply the want of important facts, which had been omitted in all the 
former accounts. These questions, together with my letter, were 
transmitted by Dr. Blane to Dr. Wilson, who, in consequence thereof, 
wrote an answer, dated December 20, 1807, explaining some contra- 
dictions which I had mentioned, between his journal and the books of 
the naval hospital at Halifax, and recapitulating his former statements, 
but without answering any one of my questions, which his memory, 
as he declared, did not enable him to do. He moreover intimated, that 
he thought it "hard to be thus called upon, at this distant period of 
time, for further proofs of accuracy and fidelity." Having thus failed 
in my endeavour to procure full information on this subject, nothing re- 
mained for me, but to employ, as well as I was able, the little which had 
been afforded : and as this did not, in any degree, weaken the reasons 
which had, from the first, made it difficult for me to believe the disease 
in question to have been the yellow fever, I shall state those reasons, 
after having premised the following additional facts and explanations, 
viz: 

It appears, from official documents, as well as from the information, 
which was given to me -verbally, on the 26th of October, 1807, by 
Mr. Sawers, who was surgeon to the Thetis, in 1795, that in conse- 
quence of the sickness and deaths of most of the men sent by the 
Hussar on board the Raison, a number of seamen belonging to the 
Thetis* were also sent on board that snip, to assist in navigating her to 
Halifax. And in Mr. Sawers' " Medical Journal of his majesty's ship 
Thetis, from the 13th of October, 1793, to the 14th of October, 
1795," the names and ages of nine of these men are stated, and against 
them, the several days, from May 27th, to June 11th, on which they 

* Mr. Sawers was not able to recollect the exact number, nor the times when sent on 
board La liaison. He thought, however, that they might amount to 15 or 10; 



496 

Were sent to the Naval Hospital, at Halifax ; and to these names and 
dates, the following explanation is annexed, viz : 

" These men were sent into Halifax in a French prize vessel. Wc 
afterwards learned she had been employed a great part of the war as a 
prison ship, at Guadaloupe, and had been very sickly, and a number of 
men had died on board of her.* When they began to move her stores, 
upon her arrival in Halifax harbour, the men began to complain, at 
different times, of pains in their heads, attended Avith rigors and shi- 
verings, and great lassitude, loss of strength, with violent retchings ; 
the matter brought up from the stomach, 1 was told, had the appear- 
ance of contaminated bile.-f A number of men from his majesty's 
ship Hussar, were also on board this vessel, several of whom died ; 
and it was remarked, that they were either very ye/low some time be- 
fore death, or turned yellow soon after it. In short, from what I 
could learn from the prize-master,! anc l other people on board, it must 
have been the yellow fever. 

" I had not an opportunity of attending those men myself, as they 
were sent to the hospital, agreeably to the dates, immediately upon 
their complaining. They were accommodated in the out apartments 
of the hospital, and in tents erected in the fields. I went frequently 
and saw them. The method of treatment was as follows: strong ca- 
lomel, or other active purgatives, were given in the beginning, and 
repeated, whenever an inclination to vomit came on, and after the ir- 
ritability of the stomach was subdued; bark, serpentaria, decoctions 
of chamomile, and other tonics, were given freely, with plenty of 
wine, and nourishment ; a? also, ripe fruits. In some cases, sluicing 
with cold water, was administered, with good effects. They all re- 
covered, which I suppose was owing to early assistance being given at 
the hospital." 

In conversation, Mr. Sawers told me that the disorder of the nine 
men belonging to the Thetis was slight, that they were able to walk 
about, but looked sallow, and had been taken to the hospital rather as a 
precaution, than from any urgency of sickness. That the Prevoyante 
had remained three or four months at Guadaloupe, after coming there 
from France, and had lost some men during that interval, by the yel- 
low fever; but that she was in good condition, and her crew very healthy, 
at the time of her capture ; and that they gave no disorder to the The- 

* This expression leaves it uncertain, whether the writer meant that these men had 
died on board the Raison, during her passage from (Saudaloupe, or whilst she was em- 
ployed as a prison ship ; but the latter eems to have been the fact. 
f This comparison dt>es not give me any better idea of the ** matter* 
j It appears, by this reference to the prize-master, that no medical assistant could 
have been senton board La Watson, notwithstandingthe great number of her own sick that, 
as is pretended, were left on board, and the additional sickness and deaths of the men be- 
longing to the Hussar : and if it had not been for the little information here given by Mr. 
Sawers, we should have had none whatever, respecting the sickness of the nine men be- 
longing to the Hussar, who died before her arrival :it Halifax. And even at this time, af- 
ter all my researches and inquiries, I am utterly ignorant how soon any one of them was 
attacked after being. sent on board ; what other symptoms, excepting turning yellow , ap- 
peared in any o' them ; how long the illness lasted, nor when any of them died. If it had 
heen wished to compel a belief of their having all died of yellow fever, by withholding 
even- thing requisite to form anyjudgment whatever, this extraordinary omission would 
have been very naturah 



497 

tis ; which ship did not send one man to the hospital after her arrival 
at Halifax, excepting the nine who were on board La Raison. It ap- 
pears, however, by official documents, that two of the crew of the 
Prevoyante, notwithstanding her good and healthy condition, died on 
the passage to Halifax, viz :— -one, a French seaman, on the 25th of 
May, — and one black seaman, on the 26th ; whilst none died of the 
Raison's crew, though represented as being then in a most sickly and 
deplorable condition. And it is moreover in proof, that after their ar- 
rival at Halifax, the sickness and mortality were much greater among 
the crew of the Prevoyante, than among that of La Raison. 

But as Dr. Wilson has given an account of his proceedings with 
the 83 sick, of the Hussar's crew, it will be proper to give a like ac- 
count, in regard to such of the crews of the French ships Prevoyante 
and Raison, as sickened before the 7th of July, after they had been 
transferred, on the 28th of May, to the prison ship, Security , at Ha- 
lifax. It appears, from the books of the Naval Hospital there, that on 
the 31st of May, eight of the crew of La Raison, were sent from the 
prison ship to the hospital ; three of whom died before the 25th of 
June, and one on the 9th of July ; and these were all the deaths from 
the crew of that shift. The other four remained in hospital four 
months ; and it seems probable, that the whole number of eight, had 
either hectical, or chronic, affections; because Mr. Halliburton, in 
his letter of the 25th of June, to the Commissioners of Sick and Hurt, 
giving an account of the sick French prisoners, says, " One or two 
hectic patients have died, but none with this fever :" meaning the sup- 
posed yellow fever: — an observation which applies equally to the 
crews of the Prevoyante, and makes a detail in regard to them unne- 
cessary. It seems probable, however, that after the crews of these 
ships had been transferred to the prison ship, they were exposed to the 
contagion of typhus, ( which is, indeed, no uncommon event, in such 
situations,) though Mr. Halliburton, and Dr. Wilson, imagined it to 
be the contagion of yellow fever. 

Mr. Halliburton, in the letter just mentioned, after giving an ac- 
count of his, and Dr. Wilson's proceedings, in regard to the. Hus- 
sar's men, supposed to be labouring under yellow fever, adds, " the 
disease now began to make its appearance on board the prison- ship, 
and as they were much crowded, I represented to Captain Home, now 
senior officer, that the same precautionary measures should be adopt- 
ed, which were pursued respecting the Hussar ; that the sick must be 
separated from the sound and healthy, and that all with susfiicious 
symptoms should likewise be removed. In consequence of which, a 
place was hired about six miles from the town, by water, called Kava- 
nagh's island, and all the sick, to the number of 3 1 , were towed there, 
in a boat by themselves, that they might have no communication with 
the ship's boats that towed them. Ten or a dozen of them were very 
ill, and many* of them were afterwards seized with it, who had the 

• It appears, by this expression that the disease did not actually occur in all who had 
the first symptoms upon them ; and this circumstance ought, perhaps, to lessen the 
regret which we must otherwise have felt, at Mr. Halliburton's not having made us at 
wise as himself, in regard to the nature of these " first symptoms." 

63 



498 

first sym/itoms upon them, when removed, but we have not as yet lost 
one of them ; and by pursuing Dr. Rush's mode of treating the Phi- 
ladelphia fever by bleeding, Sec." " has proved very successful, and 
highly pleasing and satisfactory." 

It appears by the books of the hospital, transmitted by Mr. Halli- 
burton, to the sick and hurt office, that this removal of sick prisoners 
took place on the 15th of June; and that they consisted of 17 men, 
who had belonged to the Prevoyante, and of 14 who had belonged to 
the Raison ; and certainly there never was a more harmless yellow fe- 
ver, excepting that of the men under Dr. Wilson, nor one more ac- 
commodating ; for, except one man, who, besides the fever, seems to 
have had some lingering chronical disorder, they are all stated to have 
been ill, exactly fifteen days ; so that as they had been all towed to 
the island in one boat, they might all be towed back in another.. There 
is, however, one important fact connected with this transaction, and 
which seems to have been hitherto quite overlooked ; and this is, that, 
among the 1 7 supposed yellow-fever patients from the Prevoyante, six 
were blacks, (negroes,) whose names are distincdy entered ; and of 
the 14 from La Raison, three were also blacks, though there were on- 
ly ten of that description among her crew. Now the idea of nine 
blacks, coming directly from the West Indies, where they might have 
bid defiance to the yellow fever, even when most prevalent as an epi- 
demic, and taking that disease at Nova Scotia, a place where, like 
Great Britain, from its moderate temperature, the yellow fever never 
did, nor ever will occur, (at least without a great alteration of its cli- 
mate,) must appear as ridiculous and absurd as any thing which can 
be imagined ; at least to those who may have read the preceding parts 
of this volume, or who shall have otherwise acquired competent infor- 
mation on the subject. This single fact, in my judgment, would suf- 
fice to prove, indisputably, that the disease in question, could not 
have been the yellow fever ; because the notorious insusceptibility of 
negroes, coming directly from a hot climate to a cold one, would ne- 
cessarily, according to the principles formerly stated, and the uni- 
form experience of more than a century, have been encreased, not 
diminished; but. on the other hand, their susceptibility of disi 
from typhus contagion, by such a transition from heat to cold, would 
have been augmented, as has been repeatedly observed : and this may 
explain why so great a proportion of negroes took the (typhus' fever 
[at Halifax. Dr. Blane, in his letter to Baron Jacobi, asserts, what he 
has indeed repeatedly mentioned in his other writings, that the yellow 
fever "has never been known to appear, except either in tropical cli- 
mates, or in those seasons in the more temperate climates, in which 
the atmospheric heat has, for some length of time, been equal to the 
tropical heat, that is. at, or above 80° of Fahrenheit's thermometer. 
This (he adds) is a fact incontrovertibly established by observation ; 
for there is no instance either in Nonh America, or Europe, of the 
yellow fever appearing, except at these degrees of heat, nor of its 
surviving after it had fallen to a lower degree of temperature." Now, 
if Dr. Blane, before he allowed himself to adopt and give his sj 
tion to this story, of a communication of the yellow fever, by the 
crew of La Raison, to those of the Hussar, &c had exercised his 



499 

good sense, in reflecting upon the usual and probable temperature of 
the atmosphere on the coast of New England and Nova Scotia, at that 
early season of the year, he must have been convinced that it never 
could have there attained, and much less have been " for some length 
of time," at, or above 80° of Fahrenheit's thermometer. Mr. Sawers 
told me, on the 26th of October, 1807, that on the passage to Hali- 
fax, after the capture of the Frevoyante and Raison, they had encoun- 
tered a gale of wind from the north-west, which rendered the air cool, 
as it must have done on that coast, where this is the coldest wind ; and, 
indeed, it appears by the length of the passage, .12 days) notwith- 
standing the aid of the gulf stream, that the winds must have been 
generally from the north, and the temperate, probably, was during 
that time much oftener below than above 60° : and it is well known that 
even in South Carolina, except from a rare concurrence of circum- 
stances, the yellow fever does not prevail before the month of July or 
August ; who, then, will believe, that in the frigid climate of Nova 
Scotia, it should have attacked so many persons, about the end of May 
and beginning of June ? and this though it never did before, nor since, 
appear there, even in the hottest months of the summer* 

Whatever the cause of the fever may have been, it certainly was not 
derived from, nor first applied to, the crew of the Raison ; for no one 
of them appears to have had it, until near the middle of June ; where- 
as, it is stated in the abstract of Dr. Wilson's Medical Journal, authen- 
ticated by his own signature, that three of the Hussar's men (viz. W. 
Atterly, John Lopez, and Jonas Ireland) were attacked with it, in that 
shift, on the 25th May, and two others on the 26th; and, notwithstand- 
ing all that has been strangely asserted to the contrary, the crew of La 
Raison, if any faith can be placed in official documents, were less 
sickly, and had less mortality among them, than those of either the 
Hussar or the Prevoyante. 

It would be to me a very unpleasant undertaking, were I to enter 
upon a critical examination of Dr. Wilson's general account of the ag- 
gregate symptoms of his supposed yellow fever patients ; an account 
so indiscriminating and deficient that no body can discover from it, 
whether 'the ordinary progress of the fever lasted a week or a month; 
or even whether it was continued, remittent, or intermittent; and though 
some of the 1 4 questions forwarded to Dr. Wilson were especially, and 
pointedly directed to these important circumstances, I obtained no 
answer to them. Whether Dr. Wilson was unwilling or unable to 

* Dr. Trotter, in the first volume of his Medicini Nautica, has introduced the following 

atement, at page 357, viz — 

" December 3d — most of the ships which have returned this season, (the Autumn of 
1796,) from the West Indies, have been sufferers from the yellow fever; yet the diseases 
in all of them, uniformly dissappeared ns they increased their latitude : at 32« North, 
no fresh attacks -were knoivn.'''' " The Dsedelus frigate, that arrived at Portsmouth in 
October, left the islands with this fever on board ; -so large a number of men and officers 
were affected, that captain Countess thought it expedient to push for Halifax, to land his 
sick ; but before he reached that port, the disease had taken a favourable turn, and was 
soon extirpated." If this effect was produced on the coast of America, in the hottest 
part of the Summer, how can it seem credible, that, in the month of May, and with cold 
northerly winds, the yellow fever should have made so many " fresh attacks," as were 
supposed in the Huzzar, so muchTbeyond the 3.2d degree of North latitude, and even at 
Halifax itself. 



300 

remember, is best known to himself; there is, however, one of his 
symptoms, which I cannot overlook, as the description of it seems to 
have been intended to obviate all doubt of the fever's having been the 
true yellow fever : and this is " a constant vomiting of, at first, a yel- 
low, and afterwards of a -very dark -co loured bilious matter** At that 
time, the black vomit, so called, was thought by many persons, and 
probably by Dr. Wilson, to consist in a great degree of condensed or 
dark bile, and this description seemed to have been intended to induce 
a belief that black vomiting was a common symptom among his pa- 
tients. But that I might not fall into a mistake on this particular, one 
of my questions was directed immediately to it : as another was to the 
number or proportion of the sick who became yellow;* but these 
questions, like all the others, were left completely unanswered, and, as 
I must think uncandidly ; because it is incredible that Dr. Wilson should 
not, at least, have known his own meaning in regard to the " very dark- 
coloured bilious matter" vomited by his patients ; and it was, I think, 
his duty to remove all doubt concerning it. Certainly, if what is com- 
monly understood by black vomiting had occurred, in even one of his 
83 patients, there is the strongest reason to believe that no more than 
82 of them would have recovered. And his unexampled success, if 
there were no other reasons to disbelieve the existence of yellow fever 
am >ng his patients, would render it absolutely incredible. Some gen- 
tlemen, indeed, from whom I should have expected more discernment, 
have strangely imagined that the recovery of every individual of 83 
patients, under Dr. Wilson, might be ascribed to a superiority in his 
treatment of them, without suspecting that the disease was not the true 
yellow fever; and Dr. Wilson seems to have derived credit and promo- 
tion from this mistake; which, however, is not likely to subsist; experi- 
ence having, I believe sufficiently proved, that in cases of the true 
yellow fever-, recoveries have not oftener resulted from this, than from 
other modes of treating that disease : and it will, I think, have been 
fortunate, if no mischief has been done, by an imitation of that part of 
his practice, which consisted in the giving of antimonial emetics* 

* I have already several times remarked, that yellowness of skin is not a characteristic 
symptom of the yellow fever, nor a rare occurrence in typhus ; but, on the contrary, that 
in some circumstances and situations, (particularly one mentioned by Dr. Lind) it has so 
frequently accompanied the latter fever, as to have procured for it the name of yellow 
fever. Dr. Blane has, also, mentioned a similar occurrence on board the Royal Oak, 
where a ship-fever, introduced by six men who came from England in the Anson, and 
which extended to thirty others, was attended with yellarvneas of " the eyes and itin," in 
all that were affected by it, though the disease was very mild in most of the cases. See 
his work on the diseases of 9eamen, p 1 48 and p. 552« 

• I have mentioned the danger of giving emetics in yellow fever, at p. 67, &c. and this 
danger is multiplied in a ten-fold degree, by preferring antimonials. The following is Dr. 
Moseley's observation, respecting the effects of emetic tartar, or tartarised Antimony, em- 
ployed by Dr- Wilson, to the extent of three grains, viz. " How often have I seen and la- 
mented the effects of emetic tartar, given to remove the supposed cause of the treache- 
rous symptom of vomiting ! Even in slight degrees of fever, in the West Indies, in young 
plethoric subjects, newly arrived, the stomach has been some times destroyed by it, In- 
stead of removing the irritating sickness in this (yellow) fever, or exciting a diaphoresis, a 
6pasm has been produced in J.he stomach ; incessant vomiting ; inflammation ; the vessels 
of the thorax and liead have been stifled with blood, and the patient has limited «Mtj 
life." See bis valuable work on topical diseases, &c p. 455 of the Third Edition. 



501 

That the fever which spread among the crew of the Hussar, and in 
the Security, prison ship, could have been no other than a typhus, I am 
convinced. It was, indeed, so unusually mild, and- devoid of mortality, 
that we can only account for so many recoveries, even under that fever, 
by the known effects of a warm temperature (which would have taken 
place at Halifax in June) in first moderating, and soon after producing 
a cessation of it. 

Whence the infection of this fever was derived I cannot be expected 
to explain, destitute as I am of all information respecting the commu- 
nications which the Hussar may have had with infected persons, or 
things. Mr. Sawers told me, what indeed must be otherwise highly . 
credible, that ships of war on the Halifax station, were sometimes 
known to get the contagion of typhus, by pressing seamen, and emi- 
grants^ out of merchant vessels going from Great Britain and Ireland 
to the United States, Sec. many of the latter being often taken from 
the lower classes of society, among whom that fever is but too com- 
mon. 

In regard to the fever which produced so much mortality among 
the men sent by the Hussar, on board the Raison, and of which we 
know nothing, except that some of them became yellow, either before 
or after death, it would be presumptuous in me, without more informa- 
tion, to offer any thing but (a very probable) conjecture, that it was oc- 
casioned by the foul air or morbid effluvia, contained in her hold, or 
in some other part which these men had rummaged, in search of rum, 
or wine, or other things which their appetites, or cupidity, might dis- 
pose them to plunder, and which, in a prize, they might expect to 
find, perhaps, concealed. In numerous instances, fevers resembling 
the yellow fever, and even more generally and speedily mortal, have 
been manifestly produced by exhalations from the foul ballast, and 
other decomposing matters, retained in the ships ;* and the fact stated 
in Mr. Sawers's Medical Journal, as lately noticed, in regard to the 
men belonging to the Thetis, who were sent on board the Raison, viz. 
that " when they began to move her stores, upon her arrival in Halifax, 
harbour, the men began to complain, at different times, of pains in their 
heads, attended with rigors and shiverings, and great lassitude, loss of 

* For decisive instances of such fevers, produced by these causes, see the New-York 
Medical Repository, vol. i. p. 394, vol. ii. p. 327, vol. iv. pages 2, 3, 243, 245, and 353 ; vol, 
vi. p 15 ( j ; vol. vii. pages 86, 87, and 88 ; and vol. viii. p. 71. The first instance in the 
4th vol. of this Repository relates to a yellow fever produced by the foul atmosphere of 
the hold of the America frigate, General Green, which was fatal to twenty persons, 
aqd decidedly not contagious; though some of the crew fell sick on board, several weeks 
after she had been cleansed and freed from the noxious matters producing the noxious 
atmosphere ; a circumstance, for which it then seemed difficult to account, but which, 
from what I have mentioned in a former part of this work, concerning the time that mi- 
asmata often remain inactive, may now be readily explained. See also, for similar in- 
stances, Trotter's Medicina Nautica, vol. ii. p. 97, &c. Dr Gillispie's volume, page 19 
20, 21, and 61 ; and Valentin's work on yellow fever, from p. 121 to 129. I could easily 
multiply these quotations, but I will finish with one from Dr Blane, on the diseases of sea- 
men, p 609, viz. " With regard to the effect of putrid exhalations, I need only mention 
that at the time of the battle of the 12th of April 1 782, there was not a sickly ship in our 
fleet, but many of the officers and men who were sent to take care of the French prizes, 
were seized with the yellow fever ; and it was observed, that when at any time the holds 
of these ships, which were full of putrid matter were ttirred, there was an evident in* 
crease of these fevers soon after/' 



502 



i 



strength, with violent retchings, 8tc. seems to prove the existence of a 
noxious atmosphere, or rather of matters capable of emitting noxious 
effluvia when disturbed; and this might well be expected in a ship 
which had been long employed as a prison ship, and afterwards sent, 
probably without being cleaned, to obtain a cargo in the United States, 
for France. That this fever, or that which afterwards occurred at 
Halifax, could not have resulted from contagion in the Raison, must 
be evident; because if that had been the case, as it must have been 
applied to her own crew several weeks before, and for a much longer 
time than it was to those of the Hussar and Prevoyante, the former 
would not have been among the last and Least sufferers by it. Here I 
will close this appendix, and, with it, this volume. 



JOHN B. DAVIDGE, A.M. M.D. 



NOTES. 



Page 40. 
The matter of black vomit is, notwithstanding the reports of the ex- 
aminations of bodies dead of the yellow fever, sometimes met with in 
the gall-bladder, common duct leading to the duodenum, and in the 
duodenum, in considerable quantities, as well as in the stomach. I 
have had occasion to observe this fact, and have also been informed by 
respectable authority, in which the utmost confidence may be placed, 
both as to dignity of character, and acuteness to observe, that such is 
the fact. To Dr. Wm. Donaldson, a physician of great circumspec- 
tion in observation, and extensive professional knowledge, I am in- 
debted on this head. 

That the matter of black vomit is the result of morbid secretioli, 
appears to be the opinion of some of the best informed in this city, 
Baltimore. The hemorrhage occasionally met with is, perhaps, inci- 
dental. That the liver is the # organ chiefly concerned in the secretion 
of this matter, I am strongly inclined to believe, from its presence in 
the gall-bladder, and its existence in cases where there has been no 
effusion of blood, at least, observable. 

Page 93. 
I have taught, from my Chair as Professor, for several years past, the 
doctrine, which I am much gratified to find advocated by the able pen 
of Bancroft, that putrid animal matter, simply as such, is never pro- 
ductive of fever. And although in certain habits, sickness at stomach 
and faintness may occur from the effluvia of putrid animal bodies, yet 
in regard to the production of regular fever, of whatever type or genus, 
they are wholly innocuous. 

The genius of our learned author has shed much important light on 
the subject of Typhus, arising from collections of healthy persons in 
ships, hospitals, or jails. He properly and judiciously rejects all such 
speculations, and places the affair in its proper attitude. There is no fever 
that can with propriety be attributed to any such collections of healthy 
persons. If disease, febrile disease, take place among persons erewded 

64 



506 

together in ships, or jails, or hospitals, we must look for its cause to 
some other source, than the recrementitious materials thrown off from 
the bodies; the cause is from without. When persons die under ttye 
circumstances above suggested, it is somewhat as when they die from 
carbonic acid gas ; they are killed negatively. In other words, they 
die for want of pure, repirable air ; not from any poisonous operation 
of the ffluvia. These effluvia, I hold to be, equally with those from 
putrid dead animal bodies, unproductive of a febrile disease. 

Page 122. 
In the Introduction, I have taken the liberty to prefix to this volume, 
the reader will have perceived that I have called the attention of the 
medical philosopher to the important, yet simple fact, that no feverous 
disease arises from, or with propriety can be referred to, more than some 
one simple cause, however aided that cause may be by circumstances 
incidentally disposing the body to be acted on. And that if the yellow 
fever be derived from marsh miasmata, as is proved by the ingenious 
and learned author of the present work, and is well known to be a fact, 
by every man conversant with the subject, it is altogether unphiloso- 
phick, if not absurd, to ascribe it to a poison generate^ in the body. 
All communicable diseases, so far as our researches extend, have their 
origin universally from poisons generated in the living body. How con- 
tagious diseases came first into operation, whether from climate and 
conditions of life, or original poisons created by Deity, as the various 
principles of animal and vegetable lives are, I am not prepared to an- 
swer. Much learning and talent have been displayed on both sides. 

No disease, that has its origin from a poison or cause not formed by 
the morbid action of living vessels, is communicable or contagious. 
And if the yellow fever be, a tiling occurring daily, imported from one 
country to r.other, it must be in the original materials, and not by dis- 
eased bodies; or infected clothes. I touched on this subject in my 
Sketches, published in 1798. 

Page 312. 
In the year 1797 I was, by a particular combination of circumstances^ 
led into a discussion on the nature and origin of the yellow fever. Mat- 
ters took such a course, that I deemed it proper, in the beginning of 
1798, to collect and arrange into form the scattered and fugitive re- 
marks, that, during the discussion, I had occasionally given to the 



507 

public, and to publish them in a more serious and fomtal manner, as 
the result of my most mature deliberations and judgment. 

In this small Treatise, I assumed it, as an ascertained medical axiom, 
that no marsh disease is a communicable disease ; that the yellow fevev 
is a marsh disease ; that as such it cannot be communicated by any 
intercourse of persons ; that its diffusion is co-extensive with, and at. 
tributable to the marsh effluvium ; and that no disease whatever is de- 
rivable from more sources than one : every simple effect being the 
production of a simple cause. 

Sir Gilbert Blane, although he has altogether failed in establishing 
his favourite hypothesis, furnishes an important argument for us to be- 
lieve that the yellow fever is not found beyond the influence and opera- 
tion of the marsh effluvia. So well assured is he of this valuable and 
pertinent fact, that he delivers it as his serious and professional opinion, 
" the few cases that occurred in the Hussar, after her arrival at Hali- 
fax, are to be ascribed to the inhalation of fioison in the warmer lati- 
tudes" (not to the contagion emitted from the diseased bodies on board 
of ships) ; " and ventured to assure the Ministers of Russia and Prussia, 
that their countries had nothing to fear from the importation of this 
pestilential epidemic." 

No point in medical history is better ascertained, or more strongly 
established, than that all diseases known to be contagious, are certainly 
more communicable in the colder than in the warmer latitudes. Nor 
can a stronger or more conclusive argument against the contagious 
nature of the yellow fever be brought forward than the well-settled 
fact; it does not communicate in the more cold and humid regions. 
It is well known, and wholly beyond controversy, that all poisons, ani- 
mal secretions, are more condensed, and, in proportion to their state 
of concentration, more active, in the colder than in the warmer lati- 
tudes. This holds true in regard to the small-pox, measles, chicken- 
pox, mumps, Sec. &c. and every other contagious disease which acts 
through the medium of the atmosphere. Contagions that act by im- 
mediate contact, as canine madness, siphilis, and perhaps the plague, 
act equally in the colder or warmer regions. I am writing at present 
on diseases that communicate at smaller or greater distances, without 
contact. But to return to the facts of Sir Gilbert. 

" It has never," says Sir Gilbert Blane, « shewn itself, in the fisrt 
instance, but in a sea-port town, and never in the interior of the coun- 
try, whether island or continent.'* 






508 

In scientific disquisition there is nothing less entitled to considera- 
tion, or more unphilosophic, than dogmatical gratuitous assertion. 
That the yellow fever has never, in the first instance, shewn itself but 
in a sea-port. town, is wholly gratuitous, and in direct opposition to facts 
from the most respectable authorities. From authorities, which, as 
they are not professional, and had no particular prepossession to sus- 
tain, must be viewed as the more valuable and disinterested. 

To aver that to be an uniform, or even a general fact, which has been 
the object of our personal observation only, is to proceed very far on the 
principle of the begged question. For although personal observation 
affords respectable ground on which our author is to repose his opi- 
nions, it is proper to take into account the consideration that our indivi- 
dual experience does not embrace in its range the whole field of facts, and 
may not be laid under those circumstances, as to country and climate, 
demanded by the subject in discussion. That the first appearance in 
the interior of the country, in any one instance, of the yellow fever, was 
not the experience of Sir Gilbert, is a thing very probable. But from 
such personal negative observation there can be no positive induction 
that the fever never shews itself, in the first instance, but in a sea-port 
town. The conclusion is far more than commensurate with the pre- 
mise, and such as to furnish ample reason to question the ground 
upon which it is ma'e. 

That the yellow fever does not shew itself, except in a sea-port 
town, involves a full consideration of all the circumstances of its origin. 
We are led by the position to an examination of all those sources from 
which it may possibly derive its existence: and also of the various tes- 
timonies as to facts. It must be shewn, that the original cause, what- 
ever it may be, cannot have place but in a sea-port town. The disease 
must have derived its origin from some definite cause, and under 
given circumstances. What can this cause be, and what are those cir- 
cumstances ? 

If the cause be human effluvia, it is difficult.to conceive the circum- 
stances, in a sea-port town, under which such effluvia can efficiently 
act, that could not have place in a town in the interior of the country, 
"whether island or continent. I am apprized of the operation of no 
cause or causes productive of disease, contagious or not contagious, 
exclusively the production of a sea-port town. Whether human efflu- 
via, or marsh effluvia, or any vegetable poison, be the subject pre- 



509 

s.ented to mind, I am still at a loss to conceive why, occasionally, such 
effluvia or poison might not be furnished, under given circumstances, 
in an inland as well as a sea-port town. 

That the yellow fever does not shew itself, in the first instance, ex- 
cept in a sea-port town, is, a priori, indefensible, and, I am convinced, 
in contravention of well-established facts. 

Dr. Miller, of New York, in his excellent Essay on the Yellow 
Fever, repeats a communication, highly important and valuable, by 
Mr. Andrew Ellicott, a gentleman of character, both as regards ability 
to observe, and integrity to communicate such matter, as his enlight- 
ened mind might deem worthy of communication and public notice. 

"The village of Galliopolis," says this judicious observer, " is a 
few miles below the great Kanhaway, on the west side of the Ohio 
river, and situated on a high bank. It is inhabited by a number of 
miserable French families. Many of the inhabitants, this season, fell 
victims to the yellow fever. The mortal cases were generally attended 
with the black vomiting. This disorder certainly originated in the 
town, and in all probability from the filthiness of the inhabitants, added 
to an unusual quantity of animal and vegetable putrefaction in a num- 
ber of small ponds and marshes within the village.'* 

" The fever could not have been taken there from the Atlantic 
States, as my boat was the first that descended the river after the fall 
of the waters in the spring. Neither could it have been taken from 
New Orleans, as there is no communication at that season of the year, 
up the river, from the latter to the former of those places. Moreover, 
the distance is so great, that a boat would not have time to ascend the 
river after the disorder appeared that year in New Orleans before the 
winter could set in." 

" General St. Clair," continues Miller, " who had the advantage of 
a medical education, and is, moreover, a gentleman of a discriminat- 
ing mind and distinguished talents, has assured me, that he is well 
convinced the yellow fever is an endemic complaint, in a large por- 
tion of our south-western country, where he resided as governor a 
number of years." 

Here are two interesting facts ; one communicated, in a public do- 
cument, by a gentleman who cannot be supposed to be at all involved 
in the professional question of contagion ; the other by a gentleman 
who was educated under the old doctrine of contagion. Until 1797, 



510 

when a fugitive communication or two appeared in the Baltimore 
newspapers, from my pen, I find nothing but the idea of contagion 
in any American writer, and it must be presumed that the preposses- 
sion and habits of thought with general St. Clair, were in favour of 
contagion. The circumstances of his observations must have been 
very decisive in character, for him to embrace new sentiments, and 
abandon altogether the doctrines he had received in his early years. 

With the former of these gentlemen, Mr. Ellicott, there could have 
been no conceivable reason, or interest, for him to misrepresent a plain 
fact. He could have had no professional prejudice to overcome ; no 
affair of party to support. In short, there could be nothing to gi\ 
his narrative a false or disingenuous colouring, or nd a dis- 

honest obliquity. He is not only positive as to the fact, but, by a plain 
and conclusive course of reasoning, shows that the i 
derived its origin from the circumstances of the \ ili 

In addition to the above, we are furnished with a fact or two by Dr 
Watkins, a man of distinguished talents and acute observation; and 
whose decision is the more valuable, inasmuch as he was educated in 
Edinburgh, under the doctrine of contagion, and is to be presumed 
not to be wholly free from prejudices in favour of the system of con- 
tagion. 

u There is a village," says the Doctor, " called New-Design, about 
fifteen miles from the Mississippi, and twenty from St. Louis, con- 
taining about forty houses, and two hundred souls. It is on high 
ground, but surrounded by ponds. In 1797, the yellow fever carried 
off fifty-seven of the inhabitants, or more than a fourth. No person 
had arrived at that village from any part of the country where this fe- 
ver had prevailed, for more than twelve months preceding. Our in- 
formant resided in the village at the time, and, having seen the disease 
in Philadelphia, he declares it to be the same that prevailed at New- 
Design. He also mentions an Indian village depopulated by the same 
disease, two or three years before. ; ' — Med. Rep. vol. iv. p. 

In corroboration of the above communication. Dr. Watkins, during 
a stay of a tew days in Baltimore, visited several cases of yellow IV 
with me, and gave the assurances mat he had seen, in the western 
country, pur raps allud'ng to the instances already quoted, a disease 
accompanied by all the i iivumstances and phenomena that were pre 
sfnt in the yellow fever we were then riaitine. 



511 

2dly. " No part of the population of the towns where it has broke 
out has been affected, but such as had some communication with the 
shipping, directly or indirectly." 

What sir Gilbert intends to convey by the term indirectly, it is diffi- 
cult to conceive, since no one fact on the page of faithful medical re- 
cord is more uniformly true, than that no persons residing remote 
from the sources of marsh effluvia, have ever received the disease by 
way of contagion from other persons, who have contracted the fever 
by being in the more immediate vicinity of such sources. 

Why those who may be in the neighbourhood of the shipping, will 
have the disease, is obvious. The shipping is along the wharves, and 
the wharves are, for the most part, constructed in, and sometimes of 
the alluvious soil, the very materials to which the origin of the fever is 
justly referred. That certain persons, of highly susceptible habits, 
residing at sites remote from the shipping, may be affected, is not only 
possible, but probable. It may be readily conceived, and there is re- 
spectable record to support the opinion, that by certain currents of 
air, the poison evolved by the wharves or ponds, or alluvion, may be 
carried to great distances, and applied to those highly sensitive habits, 
and produce the disease, while the general population would remain 
healthy. What given quantity of the poison is adequate to the pro- 
duction of the disease, is not ascertained ; and were it, the great varie- 
ties of susceptibility remains to be settled. Before a medical philoso- 
pher permits himself to admit the existence of contagion, he should be 
well satisfied that no marsh effluvia are present ; since few> or no men. 
are so sceptical at the present, as not to concede that this fever does, 
in the general, have its origin in poison thrown off by alluvious earth. 
Sir Gilbert Blane constantly speaks of this fever, as being present 
with the shipping. He does not surely mean that it arises from the 
ships, or the sea-air, or the sea-water. It must be ascribed to some- 
thing contained in the ships. What can this something be ? If it be 
animal matter — animal matter is found remote from ships, in all its 
possible conditions. If it be vegetable matter — vegetable matter, under 
all its changes and revolutions, is met with in places distant from ship- 
ping or wharves. If animal and vegetable matter, mixed and com- 
bined, the same mixture and combination are discovered in ponds 
and lakes, and alluvious soils in the interior of the country, whether 
inland or continent. ' If the reference be to multitudes collected toge- 



512 

ther, and living filthily, the same conditions of life are to be met with 
on land, in places to which ships can have no access, and under the 
same latitudes. 

K In the year 1798,'* says sir Gilbert, " I wrote a letter to Mr. Rums 
King, minister from the United States of America to the British court; 
and in the year 1801, another to Baron Jacobs, minister from Russia, 
for the information of their respective governments. In these letters I 
laid particular stress on what occurred regarding a French ship, taken 
in battle on the coast of America, in May, 1795, on board of which, 
this fever, or its infection, was found, and was communicated to the 
seamen of the British ship Hussar, by the men in.health, who were 
shifted into her from the prize. It is evident, that if it could be proved 
that this fever is communicable from one ship to another at sea, such a 
proof of the reality of contagion would be of the nature of an experi- 
mentum crucis, there being no possibility of land exhalations to ac- 
count for it ; such I then considered, and still consider the facts of this 
case to be ; they were, however, so strongly and so speciously con- 
tested by Dr. Bancroft, as greatly to frustrate the impressive effect 
which my statement was calculated to produce. The reader will be 
able to judge of the validity of his objections from an annotation at 
the end of this work. I feel to myself that I was so far from making 
too much advantage of these facts, that I might and ought to have 
availed myself of them still more. I might have adduced them as a 
very striking illustration of the incompatibility of the disease with a 
certain temperate degree of atmospheric heat, for the range into cool 
and pure air, in proceeding to Halifax, did in a very short time, first 
deprive it of its malignity, and then of its infectious nature, so as en- 
tirely to extinguish it. The few that were seized after arriving at Ha- 
lifax, might have imbibed the poison, in the warm latitudes through 
which they passed. It was on the strength of such tacts as these, that 
in my conferences with the members of the British parliament, and in 
my correspondence with those of Russia and Prussia, I ventured to 
assure them that in none of those countries was there any thing to fear 
from the importation of this pestilential epidemic, which in the end of 
the last century, and in the beginning of this had so afflicted the West 
Indies, North America, and Spain, as to excite a general alarm 
throughout Europe." 



513 

" There is another useful remark which I did wrong in omitting m. 
my statement of fourteen men sent from the Hussar to navigate the 
prize, nine died before reaching Halifax, a passage of twelve days ; the 
©ther five were sent to the Hospital, where some of them probably 
died." 

In the two paragraphs, just quoted, Sir Gilbert Blane has given what 
he terms the experimentum crucis. From them I expect to derive 
such proof as will be satisfactory to all, in any degree acquainted with 
the nature of the subject, that there is not in the circumstances detail- 
ed, the slightest evidence in favour of the hypothesis of contagion. 

" It is evident," says Sir Gilbert, " that if it could be proved that this 
fever is incommunicable from one ship to another at sea, such a proof 
of the reality of contagion, would be of the nature of an experimen- 
tum crucis, there being no possibility of land exhalations to account 
for it." 

It has never before been suggested by any writer, that the yellow 
fever, as to its origin or cause, is attributable to land exhalations. I 
was not aware that land, as land, evolved any exhalations to which any 
fever could be legitimately traced. It is only contended that the yellow 
fever is properly ascribable to a certain condition of vegetables, whether 
on land or on board of ship. And, notwithstanding the authority of Sir 
Gilbert, I am still disposed confidently to believe, that putrid coffee, or 
cabbages, or potatoes, or flax-seed, &c. &c. would be the same, in na- 
ture and effect on board of ship, as on the land. The profession, no 
doubt, will be amused, if not instructed, to hear from such high and 
respectable authority, that the yellow fever is derived from land exha- 
lations ; or that it is necessary for putrid vegetable matter or foul water 
to be on land, to emit the noxious poison from which this fever draws 
its origin. 

Hitherto it has been presumed, and really I thought the opinion 
rational and modest, that vegetable or animal substances, in a given state 
of putrefaction and quantity, would, other circumstances being equal, 
produce the same effects at sea as in harbour. But it appears that the 
common sense of the world, acting upon the experience of all ages, 
has been wrong; place and vehicle are every thing ! 

Perhaps, however, Sir Gilbert, or those who conceive his facts and 
arguments to be decisive, can furnish the rationale, why a foul ship, a«* 

65 



514 

the French prize is acknowledged to be, lying along-side of a clean 
ship, at sea, could not, as readily and certainly, by poisonous exhalations 
evolved from her foul materials, produce disease in the seamen of the 
healthy ship as in harbour. 

To my understanding the proximity and relative position of the ships, 
the exhalations and presence of healthy excitable bodies, the inter- 
course between the ships, would result in the same on the ocean as at the 
wharf. 

Sir Gilbert says nothing of the relative position of the ships while en- 
gaged in battle, or after the French struck her colours to the English 
ship; not whether they fought in contact, in grappled relation ; nothing 
as to the course of the wind, whether from the foul French ship to the 
healthy British seamen, nor whether the French ship was boarded after 
the fight, by way of taking possession of her, by the British seamen; 
nor whether the very seamen who took possession, in part, at least, were 
not those, who after the ships set sail for Halifax, became diseased. 

An inquiry into the above is of primary importance to me : but to 
Sir Gilbert and his admirers it may not be so necessary. They arc 
satisfied that no land exhalations were present. 

As the facts now stand stated, there is no more evidence or probability 
of contagion, than if I were, with a company of armed men, to approach 
a wharf, or any other source of foul alluvious ground, engage in battle 
prove victorious, take possession of the unhealthy district, and, after 
the delay of some hours, necessarily consumed in making arrange- 
ments, within the range of the miasmata, again continue on to my des- 
tined position, taking with mc a few healthy prisoners, there would be, 
that my company would be diseased by the healthy men taken, and not 
by the poisonous exhalations which had been inhaled during the con- 
test, and the delay in the neighbourhood of the alluvious ground. And 
were I 10 give publicity to the opinion, that the company attacking, most 
certainly took the disease from the healthy men, and not from the foul 
district, my ignorance, I believe, would meet with little else, from men 
of science, than pity or contempt. 

The cases are parallel as far as regards even' thing that can be con- 
ceived to be efficient in the production of the disease^ 

To know how very foul the French ship was, we have only to admit 
the evidence of Sir Gilbert, " that of the fourteen men that were put 
on board the prize to navigate her into Halifax, in the course of twelve 



515 

days nine died, and the remaining five were sent diseased to the Hos- 
pital, where probably some died." 

Certainly bo ship could be more foul ; but yet, not a word is said of 
the medical men, nurses, or patients in the hospital. Was the disease 
communicated to them? No. Did the fiurity of the air of the Hos- 
pital check the contagion ? A contagion can act at sea, in the purest 
air, but cannot be propagated in a Hospital ! Had a few of the citizens 
of Halifax paid a visit to the foul prize, they, in all probability, would 
not have found the air of such purity, as to have kept them in safety. 

Can credulity itself admit that a contagion which, on board of ship, 
is so virulent, as not to permit a solitary man, out of fourteen, to es- 
cape, and yet to become weak and innocuous the instant it is placed 
within the walls of an Hospital ! 

In regard to the British ship, the liussar, we are told that the sea- 
men were infected by the healthy taken from the prize ship. Sir Gil- 
bert does not enter into particulars ; he does not say all her seamen. 
Yet the phrase, the " healthy men from on board the prize communi- 
cated to the seaman of the Hussar," does, by liberal interpretation, mean 
the whole. Or Sir Gilbert may mean that the healthy men from the 
prize, communicated the fever to the men of the Hussar who had been 
on board the prize. 

That he does not mean the whole of the men of the Hussar is cer- 
tain, from -what follows. " The few that were seized after arriving at 
Halifax, might have imbibed the poison in the warmer latitudes through 
which they passed." And if the few who were seized after arriving at 
Halifax, imbibed the poison while passing through the warmer lati- 
tudes, what certainty is there that the few or many that were seized 
before her arrival at Halifax, did not derive the poison from the same 
source — the warmer latitudes. Or from a source far more probable, 
the exhalations of the prize while engaged in battle with her, and sub- 
sequently during the stay in her neighbourhood. The marsh efiluvia 
will evolve its effects in morbid phenomena, after the lapse of eighteen 
or twenty days, or indeed several months. I write from personal ob- 
servation and knowledge. See Bancroft, p. 81. 

" There have occurred, since the period alluded to, facts equally 
conclusive, regarding the communication of the disease from one ship 
to another. It will be enough to specify one or two, A French ship 
of war, the Palinurus, lying at Martinique, severely affected with the 



516 

yellow few, was ordered on a cruise, to try the effect of sea-air on 
the disorder. She fell in with and captured the Carnation, a merchant 
ship, on her passage from England, part of the crew ofrwhich were 
seized with the fever while at sea. Another French ship of war, in 
which this fever prevailed, both at St. Domingo, and on her passage 
to Brest, made prize of a merchant ship from the Mediterranean, off 
Cape Finisterre, and having, without shifting the persons, sent a party 
of their own seamen to navigate her, the crew of the prize caught the 
fever, and almost all died of it. The men having been seized on 
board of their own ship, makes it a stronger case than the other, in 
which this circumstance is not mentioned ; had they been taken ill on 
board the capturing ship, it might have been said, that it was from the 
exhalations of the hold or stores." 

In the affair of the Palinurus, the narrative, as far as it goes, amounts 
to but little. It is not stated, whether the men were changed from 
the merchant to the foul ship. It is only affirmed, that the Palinurus 
captured a merchant ship from England, and that a part of the crew 
were seized with the fever while at sea. It may fairly be presumed 
that the healthy men were translated to the French ship, for Sir Gil- 
bert appears at this stage of his argument, to be quite sensible of the 
possibility, perhaps certainty, of the disease being communicated by 
the " exhalations of the hold and stores." And had the capturing 
ship sent her men on board the merchant ship, he would have been 
careful to take advantage of the fact. The case of the Palinurus, 
therefore, might, with no loss to the argument, have been omitted in 
this catalogue of imaginary facts. It is altogether without bearing on 
the subject. 

The second case carries with it, at first \ic\v, some speciousness 
and plausibility. It however, conveys us to the old ground, and we 
liave again to inquire, at what distance did the merchant ship remain, 
after capture, and while she kept with the ship of war, affording facili- 
ties for the removal of the men from the ship of war, together with the 
body and bed-clothes to her own cabin? With the men, provision 
for their support until they could arrive at Brest, was, doubdess, con- 
veyed from one ship to the other. This provision, possibly, might be 
vegetable, and this vegetable matter not in the sweetest and soundest 
condition. Might I propound the question, — Was this disease at first 
produced, and afterwards kept up, by this provision ? On land, nothing 



; 



517 

more -usually gives origin to fever, than putrid cabbages, pota- 
toes, Sec. 

Without the least violence to probability, or even fact, it may be 
admitted, that the two ships lay in convenient relation to each other, 
side by side, or at a short distance. The two ships, under such cir- 
cumstances, would of necessity be involved in the same exhalations, 
which, Sir Gilbert acknowledged, in the other ship, to pour out from 
the hold and stores very copiously. Twenty minutes may be, equally 
with twenty days, sufficient time for the poison to make its impression. 
From the great mortality the poison must have been active and con- 
centrated. 

All that is said derives probability and strength from the fact that 
the capturing was the foul ship. Hence there could be no possible 
reason why the two ships should keep at a distance. 

It is not said that, on the arrival of the ship carrying those, almost 
all of whom died on their way to Brest, the disease was communicated 
to any persons of the town or hospital. 

Neither Sir Gilbert, nor any of his admirers, will tell us that the air 
of a city or hospital, is better suited to put a stop to a contagious dis- 
ease than the pure air of the ocean. While on board of ship, as in the 
affair at Halifax, the disease operated ; but when the men were re- 
moved to the hospital, it ceased. Nothing can be more clear and con- 
clusive, than that the poison was in the ship, and not in the persons. 

Such are the facts which have afforded cause of great triumph to a 
writer, in a late number of the Medical Recorder ; a book deservedly 
of extensive circulation, in favour of the opinion, that the yellow fever 
is a contagious disease. Facts, from which my mind, were they insu- 
lated, and the only known facts in relation to the fever, would deduce 

e opposite conclusion, or surrender its privilege of thinking and 
reasoning. The assertions of sir Gilbert Blane, and the pretty and im- 
passioned declamations of his friends, being laid aside, there is nothing, 
as I hope, the reader perceives, in his facts, to induce even a careless 
inquirer to believe otherwise, than that the yellow fever is of the marsh 
progeny, and incommunicable. Dr. Bancroft had great reason, in r 
deed, to contest the subject, and weaken the confidence of any Board? 
in the opinions and conclusions of sir Gilbert. 



518 



Page 337. 

It is gratifying to the cultivators of science, and highly beneficial 
in the promotion of patient and successful research, to see such abili- 
ties and professional knowledge, as possessed by Armstrong and Ban- 
croft, blending their powers and influence in recommending the im- 
portant, and I apprehend defensible doctrine, that the typhus fever is 
a contagious disease, and referrible to a generick poison alone, in the 
same manner as small-pox, canine madness, &c. Sec. 

While I refer the reader to the work of Armstrong, for the facts 
and the arguments, he will excuse me, if I quote a sentence or two 
from his valuable pages. His opinions are so pertinent, and so natu- 
rally constitute a part of my present subject, I cannot avoid doing my- 
self the pleasure of recording them. 

At page 7, says Armstrong, " It strikes me, that to call any species 
of fever typhus, which has not the contagious' essence, capable of pro- 
ducing an unequivocal typhus, is equally incorrect in logic as in lan- 
guage. In this essay, therefore, the word typhus shall be limited to 
the peculiar disease, which is allowed to originate from a sfiecijic con- 
tagion, and which, doubtless, has the power of producing an affec- 
tion of its own nature, in individuals exposed to its influence." 

The typhus is not, so far as my observations have extended, a dis- 
ease of Maryland, perhaps not of America ; at any rate, not south of 
the New-England states. And since, as Armstrong and Bancroft, 
and most other enlightened physicians, admit contagion as essential to 
typhus, (I here refer to the typhus of Britain and Ireland) it must be 
highly absurd to speak of the typhoid condition of diseases, in regard 
to those diseases that are not admitted to be contagious in any stage. 
For surely, no disease can be said to be like another, that is deficient 
in an essential quality. Hence it appears, how unphilosophic the lan- 
guage is, that states the low and collapsed condition of the body, in 
remittent bilious fever, synocha of the winter, or pneumonia, to be 
typhoid. Those diseases are wholly distinct from typhus, in all their 
stages, cause, and sensible phenomena. 



519 



Page 369. 

In my nosology, I have considered the plague as a species of 
typhus. More extensive reading, and the consultation of the more 
modern and enlightened authorities, have, however, satisfied me that 
I was not correct. The plague, upon the authority of those who ap- 
pear to have had the best opportunity to observe it, is an exanthema- 
tous or eruptive disease, and as distinct in nature and character from 
typhus, as from small-pox, or measles j it is a disease sui generis. 



THE END. 



MHMMi 



INDEX. 



A. 

Aberkethy, Mr. quoted for a case of black vomiting without yellow 

fever, p. 26, n. 
Adams, Dr. quoted in regard to variolous and vaccine infections, 9 1 , n. 

His opinion that febrile contagion may be generated by crowding, 

contested, 338. His mistake respecting the Old Bailey session, 1750, 

445, n. 
Agathias, quoted respecting the plague in Justinian's reign, 392, n. 
Aine, J% J. Job, his deputation to Cayenne, 104. 
Akenside, Dr. his opinion of Dysentery, 354. 
Appendix, No I. On the nature of the black vomit, and the condition 

of the stomach, Sec. in yellow fever, 415. 
, No. II. Proving that putrid animal effluvia do not cause 

fever, 420. 
, No. III. Proving that the crowding in the black hole at 

Calcutta, did not produce fever, 425. 

, No. IV. Facts respecting the black assize at Oxford, and 



the spring sessions at the Old Bailey, 1750, 430. 

, No. V. Hotel Dieu, at Paris, 446. 

, No. VI. Salubrity of Peat bogs, 447. 

, No. VII. Confutation of Dr. Chisholm's account of a " Ma- 



lignant pestilential fever" supposed to be brought to Grenada by the 

ship Hankey, 447. 

, No. VIII. Controverts the alleged communication of yellow 



fever from the French prize, La Raistfn, to the crew of his majesty's 

ship, Hussar ,488. 
Anjula, Dr. his account of the yellow fever in Andalusia, 307. 
Armesto, Dr. Rodriquez, his account of the yellow fever at Cadiz, 303. 

66 



522 



B. 

Bacon, Lord Chancellor, his opinion concerning human putrefaction 
and jail infection, 93. 

Baglivi, quoted respecting the effects of marsh miasmata at and near 
Rome, 165. 

Balfour, Dr. his designation of Dysentery, 353. 

Bartholina, Thomas, his account of a marsh fever at Copenhagen, 209. 

Batavia, accounts of, 127. 

Baussard, Mr. his dissection of a putrid whale, 423.. % 

Baynard, Dr. Edward, quoted respecting the weather during the plague 
of London, 1665, 404, n. 

Beaver, Captain Philip, quoted in Appendix, No. VII. passim. 

Berthe, Professor, sent by the French government to enquire concern- 
ing the yellow fever, 44. n. 

Black Assizes at Oxford, 1 10. 

at Exeter, 111. 

at Taunton, ibid. 

Black hole, at Calcutta, 108. 

skin diminishes the sun's rays, 193. 

vomit, not peculiar to the yellow fever, nor a constant symp- 
tom, 39. 

Blane, Dr. his opinion of the Black vomiting, 45. 

Boghurst, Mr. William, quoted respecting the plague, 410. 

Bourgeois, M. mentions a remarkable difference between Creole and 
African Negroes, 195. 

Brocklesby, Dr. mentions the yellow suffusion of the skin in marsh 
fever, at the Isle of Wight, 211. 

Buce, Mr. William, his account of marsh fever and dysentery, at 
Sheffield, in New England, 355. 

C. 

Caldwell, Dr. asserts the temperature at Philadelphia to be from four 
to six degrees above that of the surrounding country, 191. 

Chalmers, Dr. his account of the effects of heat and moist, in South 
Carolina, 187. 

Chirac, M. his account of the vellow fever at RocheforU 2 



62% 

Chisholm's, Dr. observations on his practice of exciting salivation, 74. " 
in Appendix, VII. 

Clarke, Dr. James, of the influence of the weather in producing yellow " 
fever, 149. 

, Dr. John, his account of the violent effects of marsh effluvia at - 

North Island, 79. 

Clay in soils, favours the generation of marsh miasms, 85. 

Coxe, the Rev. William asserts that jail fever does not exist in Russia, 
116. 

Cullen, Dr. his definition of yellow fever, 25, of typhus, 337, of dysen- 
tery, 353, of the plague, 576. 

D. 

Dancer, Dr. his account of the expedition against St. Juan, 195, n. 
Davidge, Dr. his account of the yellow fever at Baltimore, 252. 
Deidier, Dr. rejects the use of mercury in the plague, 411. 
De Roset, Dr. of the yellow fever in North Carolina, 249. 
Desgenettes, Dr. quoted respecting the plague, 398, &c. 
Devize, M. of the yellow fever at Philadelphia, 257. 
Deimerbroeck, of the plague, 377. 

Du Tertore Pere, of the yellow fever at St. Christopher's, &c. 224. 
Dysentery, when epidemic is connected with marsh miasmata, 355. 



Eckard, Mr. Danish Vice-Consul at the Philadelphia, corrects some 
of Dr. Chisholm's gross misrepresentations, 463. 

Epidemic, definition of, 8cc. 29. 

Evagrius, Scholasticus, his account of the plague in the reign of Jus- 
tinian, 372, n. 

Exhumations at Dunkirk, Sec. &c. 95. 



Fellows, Sir James, his letter to the author, 330, n. 
Ffirth, Dr. his experiments with the matter of black vomit, 291. 
Fontana, L'Abbe, his opinion of the yellow suffusion produced by the 
poison of vipers, 5 1 7 



524 

Fontana, Nicholas, his account of the morbid effects of marsh miasms, 

122. 
Fordyce, Dr. George, that pure aqueous vapours produce fever, 127, 

&c. Sec. 
Forestus, his account of a fever caused by a putrid whale dissected. 

G. 

Gilbert, Medecin au Chef, &c. 234. 

Gilchrist, Dr. Ebenezer, 342. 

Gillespie, Dr. of the production of marsh fevers, 125. 

Gonzales, Dr. his account of the yellow fever at Cadiz, SI J. 

Grainger, Dr. quoted concerning dysentery, 368. 

Grant, Dr. (Jamaica) denies the supposed contagion of yellow fever, 

244. 
Guthrie, Dr. his account of the Russian peasants, 101. 

H. 

Hamilton, Dr. Robert, his account of marsh fevers near Lynn Regis. 

209. 
Haygarth, Dr. 81. 
Heberdeen, Dr. quoted, 31. 
Herring, Dr. quoted, 405. 
Hodges, Dr. quoted, 403. 
Holwell, Mr. black hole of Calcutta, 4 
Hosack, Dr. of the yellow fever, 273. 
Himter, Dr. John, black vomit, 48. 

J. 

Jeeferson's, Mr. official declaration, 295. 

K. 

Kennedy, Dr. Gilbert, 298. 

L. 

Lawrence, Mr. his letter on the innocency of exhalations from putrid 
human bodies, 420. 



525 

Lind, Dr. James, 26. 
Lining, Dr. yellow fever, 260. 

M. 

Morton, Dr. remittent fever formerly prevalent in London, 401, 

N. 

Nooth, Dr. judges rightly that the yellow fever at Gibraltar was not 
contagious, 327. 



Poupee Desportes, M. on the yellow fever of St. Domingo, 150. 
Plague, definition, Sec. &c. 369. 

R. 
Ramsay, Dr. David, 245. 

S. 

Selden and Whitehead, Drs. yellow fever in Virginia, 250. 
Stomach, its high importance, 40. 

T. 
Typhus, jail, a contagious fever, 337. 

U. 
Ulloa, Don Antonio, his account of Peru, 134. 

V. 

Vapour, pure aqueous, not a cause of fever, 132, 

Y. 

Yellow Fever, different appellations of, 25 — observations on its 
generic and specific names, 25 to 29 — distinction between sporadic 
and epidemic, 29, 30 — symptoms of, 30 — parts most affected, 35 *» 



526 

dissections of bodies dead of it, 36 — black vomit, 39 — affections of 
the skin, 46 — diagnosis of, as distinguishing from the plague and 
typhus, 56 — treatment, 58— causes of, 122— proved not to be con- 
tagious, 332. 



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